Category Archives: Medicare

Medicare Advantage Plan

Medicare Advantage Plan: When you are looking into Medicare for either diabetic supplies or any other type of health issue that requires monthly prescriptions you must know some things about it. First, you should recognize that there are so many parts of Medicare plans to choose from and while Part A and Part B are covered under the Original Medicare Plan, many people are looking further into other plans such as Medicare Advantage.

Medicare Advantage is a plan that allows for private health insurance plans inside the Medicare program to be chosen instead of standard Medicare plans such as Plan A and Plan B. Members will receive their health care needs from a private plan while Medicare pays a certain amount of money monthly. It does not matter if the member actually uses health care services that month or not.

With Medicare Advantage members are supplied with lower co-payment costs as well as extra benefits. However, just like with members who are on the Original Plans A and B, members must use doctors and hospitals that are located on the plan roster.

You do not have to do anything special or pay extra or have any special concerns to be part of Medicare Advantage, you just have to sign up for that particular plan. If you are eligible for Medicare Parts A and B than you are eligible for Medicare Advantage, as long as the pre-member lives in a area that is available for Medicare Advantage.  There are certain areas that do not have Medicare Advantage although the issue is currently being worked on to supply the plan to rural areas without it.

When it comes to the Medicare Advantage program, there are different ways that the program itself works. For instance, some private insurance plans will pay a certain amount of your Medicare A and B plans would. Others will pay the whole premium. Nearly all private insurance programs will cover drug prescriptions and many other benefits that are not covered on the Medicare Plan A and B.

Even if you chose Medicare Plan A or B in the beginning of choosing Medicare as your health provider, you can still switch Medicare Advantage as soon as you want to. Medicare Advantage is more helpful than other plans but can have unnecessary benefits if you are looking for something much simpler.

Check into the Medicare Advantage plan and remember that health care is always changing therefore the best thing that you can do is to keep yourself updated about Medicare changes and the best way to do that is by looking up updates online.

Therapeutic Shoes: Preventing Foot Disease

Therapeutic Shoes - Preventing Foot DiseaseThere are over 24 million Americans who have been diagnosed with diabetes and more than 25 percent of them will develop some sort of foot complications that may need to be amputated. Annually, 38,000 elderly individuals loose a lower appendage due to complications that derive from diabetes. This is why it has become important for anyone who has been diagnosed with diabetes to own a pair of therapeutic shoes. Therapeutic shoes can be expensive, no doubt, but if you have Medicare, then you could save a lot of money when you buy a pair.

Medicare Part B covers therapeutic shoes as long as your doctor prescribes them. Here are some issues that doctor’s look for when it comes to assessing your feet for the need of therapeutic shoes.

  • You must have diabetes type 2
  • You must have one of the conditions listed below
  • Calluses that could lead to foot ulcers
  • Partial or complete foot amputation
  • A history of foot ulcers
  • Nerve damage caused by diabetes
  • Deformation of the foot
  • You must be diagnosed with diabetes and are being treated under a diabetes care plan that states you need therapeutic shoes or inserts.
  • Medicare also requires that a orthotist, pedorthist or prosthetist fit and provide the needed therapeutic shoes

Therapeutic Shoes and Inserts Offered by Medicare
There are certain types of shoes and inserts, which are covered by Medicare.

  • One pair of depth-inlay shoes/ three pairs of inserts
  • One pair of custom-molded shows/ inserts
  • If wearing depth-inlay shoes due a deformity of the foot, than two you will receive two additional pairs of inserts.
  • On certain occasions that call for it, Medicare will offer to cover inserts or show mortifications instead of inserts.

There are ways that individuals who have diabetes can prevent the need for later amputation and one of those ways is by wearing the proper shoes. However, there are so many others ways that one can take care of their feet and it all starts with knowing exactly how. Here are some ways to protect your feet:

  • Wear therapeutic shoes
  • Diabetic shoes are made to provide comfort, enhance protection and help deflect injury.
  • Wear socks
  • Most people do not like to wear socks. However, socks can act as a buffer to stop scratches and scrapes that could ultimately lead to something bigger.
  • Follow your exercise and diet closely.
  • Skimping here and there is not good. So keep up the hard work to achieve great rewards.
  • Select some time throughout the day to inspect your feet.
  • Look for blisters, swelling, cuts and red spots. Make sure you check really well in between your toes. If you find an ingrown toenail, you should contact your doctor to find the best solution for removal.
  • Tell your doctor if something changes.
  • Your doctor should know the ends and outs of your foot. If it changes color, or feels unlike your foot or changes shapes than your doctor needs to know.
  • You should go for a yearly check-up, just for your feet.
  • Even if your feet feel great, you should still go for a yearly check-up. It is important to make sure you are not missing anything.
  • Your feet should be washed daily, patted dry and rubbed down with a mild lotion.
  • Do not put lotion in between your toes.
  • Keep your toenails trimmed and filed to prevent issues with toenails or scratching in the middle of the night.
  • Keep your shoes on; it is important that you never walk around barefooted.
  • If you just cannot stand to wear shoes, than slide into some socks. Nevertheless, never go barefooted.

These are all important tips to keep in mind when it comes to your feet. You are their protector and you can be a huge part of keeping them safe and from a harmful future. Take care of your feet.

Medicare Covered Diabetic Supplies

Medicare Covered Diabetic SuppliesThrough Medicare, many different kinds of diabetic supplies can be acquired and the cost to your pocket is substantially less than what you would pay outright for it, had you not had Medicare. Medicare will cover the cost of diabetic supplies as long as you have diabetes, you will have to produce a blood test in order to get things rolling, but once you have Medicare you will be able to obtain your supplies as long as your doctor prescribes your need for them.

Here are some things to keep in mind when applying for Medicare help for diabetic supplies:

  • Receiving Medicare through a Medicare Advantage Plan like HMO or PPO will have you follow a different method in order to obtain your supplies but once you have received all the paperwork from your plan, you will know exactly what you need to do.
  • For other Medicare plans, your doctor is the only person who can prescribe diabetic supplies for you. Ordering without a doctor’s prescription is a waste of time.
  • Your doctor not only has to write a prescription, they must also document a need for it through medical records and give you the prescription as well.
  • Once this has been completed, the supplier must receive that prescription before Medicare is billed.

List of Supplies Covered by Medicare:

Medicare Part B helps to cover many different supplies needed for diabetic patients rather they need insulin or not. However, for those who do use insulin the amount of diabetic supplies an individual has covered varies. Some individuals who use insulin could obtain 100 test strips and lancets monthly and one lancet device every six months. Others who do not use insulin may be able to obtain 100 test strips and lancets every three months and one lancet device every six months.

Insulin and Insulin Pumps
Medicare Part B will not cover insulin if it is not used with insulin pump; however, injected insulin is covered by Medicare Part D and can be supplied through that plan. All insulin and needed supplies such as needles, syringes, and gauze and alcohol swabs will be supplied. External insulin pumps including the needed insulin can be covered through Medicare Part B, as long as it is prescribed by your doctor. Typically, Medicare will pay 80 percent of the cost of the insulin pump itself.

Therapeutic Shoes
Foot disease is a growing problem with those who suffer from diabetes, especially for elderly people. That is why therapeutic shoes are so important and since they are covered on Medicare, there is no reason why no one who is suffering from diabetes cannot own a pair to keep future foot problems away. Medicare will not only cover the therapeutic shoes, they will also cover one pair a year and three pairs of inserts for them.

You know that Medicare will cover your diabetic supplies, but you should also know just how much they would pay. The amount that Medicare will pay depends on the type of coverage you have and where you are buying your supplies at, first you must realize that there is a yearly deductible, which must first be paid before Medicare will cover the cost of diabetic supplies. Once that is paid, you will then pay 20 percent of the approved diabetic supplies. The cost is cut down a certain amount if you choose to go with a diabetic supplier. However, if you received your Medicare through a Medicare Advantage Health Plan such as HMO or PPO, than you may end up pay a very small amount of even nothing at all for your diabetic supplies.

Your supplies are affordable but you should always do a little research when it comes to Medicare, new bills are always being passed on what Medicare will or will not cover and the more you know the better off you will be as a Medicare carrier.

Discovering Medicare and Diabetes

Discovering Medicare and DiabetesIf you have diabetes than you already know the financial burden test strips, lancets, monitors and control solution can leave on you. Monthly you shell out a few hundred dollars for all your test supplies and they just do not seem to last long enough before it is time to shell out another hundred dollars or so. It can be quite a pain in the bank but that does not mean it has to be.

If you have diabetes, there is a chance that you can apply for Medicare. Medicare will not only help you afford your supplies every month, it can also help with other supplies that could be needed in the future, such as a therapeutic shoe to prevent foot disease. There are several parts to Medicare, which you must understand before applying for it. Here they are:

Medicare Part A aka Hospital Insurance is helpful when you are a patient within a hospital; it can also be helpful in times of home health care, hospice care or to cover the expenses of a nursing facility.

Medicare Part B
aka Medical Insurance is helpful in covering expenses toward doctor’s bills or outpatient care bills. It can also be helpful to make sure that illnesses do not become worse than they are.

Medicare Part C aka Medicare Advantage Plans such as HMO or PPO, this is health coverage that is setup through private companies and assesses both Part A and Part B in order to cover the costs of prescription drugs.

Medicare Part D aka Prescription Drug Coverage is helpful in covering the high costs of prescription drugs. It can lower the cost of your prescription drugs and keep those high costs at bay in the future.
You can get many different supplies from Medicare. You may already qualify for these supplies if you are on Medicare or have a blood test showing you are a diabetic.

Here is a list of supplies covered by Medicare:

Most likely, you are thinking this all seems like a pretty good idea to save some money, but you may be asking yourself, “How do I get my supplies?” The answer is simple really; you can get your supplies a couple of different ways. One of those ways is through a Medicare participating provider such as a medical supply store or a local pharmacy. Another convenient way to obtain your supplies is by setting up a monthly delivery order, to your doorstep via the internet or snail mail through a diabetic supply company.

You should keep in mind when you order your supplies that you will need to ask for refills monthly, you will need a new prescription from your doctor to obtain additional lancets, and test strips yearly.

Becoming a diabetic and living with diabetes is hard as it is but knowing that you have full coverage when it comes to doctor visits, high cost drug prescriptions, hospital visits and even long-term nursing facility care, can make things a little better. Diabetes is a lot less of a struggle when you can afford the supplies you need to take care of yourself, look into Medicare today.

Can Medicare Cover Insulin Pumps for Patients with Type 2

medicare and insulin pumpsDiabetes can be hard to live with, it does not matter which type you have. It could be type 1, type 2 or gestational diabetes; they are all very difficult to live with. Type 2 diabetes however, is the most common diabetes out there among millions of Americans who have been diagnosed with it. Type 2 diabetes appears to be more common in Latinos, Native Americans, Asian Americans, Native Hawaiians and African Americans.

A person who has type 2 diabetes is dealing with either a body that is unable to produce insulin or cells that ignore insulin. For the body to work properly, insulin is necessary. Glucose turns into energy, therefore any food that you eat will break down all the sugars and starches into glucose, which will in turn, fuel the cells in the body. Glucose can start to build up in the blood, rather than in the cells, which ultimately starts a long path of diabetes complications.

For those who have type 2 diabetes, the diagnosis used to be simple. Get plenty of exercise and watch what you eat. If you eat a lot of sugars and starches than the problem gets a lot worse. This diagnosis is fairly easy for many people and there are people who were pre-diabetic and seem to be handling life well at the moment by not showing any signs of becoming a full-blown diabetic. However, what happens when diet and exercise are not enough? What happens when a person has done all they can to help their blood sugar level out but it still skyrockets or drops suddenly, without much warning? For these individuals, it used to be a hard diagnosis to make, but now there is an easy answer and the answer is yes. Yes, a person with type 2 diabetes can be covered by Medicare when they need an insulin pump. However, just as if with any other diabetic supplies you need, you must have a prescription from your doctor.

Medicare used to only cover insulin pumps for patients who had type 1 diabetes, but since there is a growing issues with type 2 diabetes, there is a growing need for insulin pumps for patients who do not have type 1 diabetes are still battling insulin issues.

To receive a pump you must have to following:

  • Type 1 insulin-dependent Diabetes
  • Type 2 insulin-dependent Diabetes
  • Gestational Diabetes with a blood sugar that in uncontrollable.
  • Written prescription from your doctor
  • Medical records showing that you what you claim
  • Complete a diabetes education program
  • Completed a program of at least 3 daily insulin injections with frequent adjustments of insulin dosage for the past six months
  • Self-testing documentation for the past two months that shows four times a day testing

Once you are approved, for an insulin pump, you will save the most money if you go through a Medicare approved provider. When it comes to diabetic suppliers, they must meet a very long list of strict standards. It is possible to order your insulin pump from any store that sells that, however, if they supplier is not enrolled in Medicare, Medicare will not pay for the pump leaving you with the bill.

Diabetes and Medicare Supplies – Part 2

Diabetes and Medicare Supplies – Part 2If information is power than knowing as much as you can about the Medicare benefits you’re entitled to can be very helpful in your care. The Center for Medicare and Medicaid Services provides more details.

Before a beneficiary gets a supply, it is important for them to ask the supplier or pharmacy the following questions:

  • Are you enrolled in Medicare?
  • Do you accept assignment?

If the answer to either of these two (2) questions is “no,” they should call another supplier or pharmacy in their area who answers “yes” to be sure their purchase is covered by Medicare, and to save them money.

If a beneficiary cannot find a supplier or pharmacy in their area that is enrolled in Medicare and accepts assignment, they may want to order their supplies through the mail, which may also save them money.

Therapeutic Shoes and Inserts
If a beneficiary has Medicare Part B, has diabetes, and meets certain conditions (see below), Medicare will cover therapeutic shoes if they need them. The types of shoes that are covered each year include one of the following:

  • One pair of depth-inlay shoes and three pairs of inserts; or
  • One pair of custom-molded shoes (including inserts) if the beneficiary cannot wear depth-inlay shoes because of a foot deformity and two additional pairs of inserts.

Note: In certain cases, Medicare may also cover shoe modifications instead of inserts.
In order for Medicare to pay for the beneficiary’s therapeutic shoes, the doctor treating their diabetes must certify that they meet all of the following three conditions:

  • They have diabetes;
  • They have at least 1 of the following conditions in one or both feet:
  • Partial or complete foot amputation;
  • Past foot ulcers;
  • Calluses that could lead to foot ulcers;
  • Nerve damage because of diabetes with signs of problems with calluses;
  • Poor circulation; or
  • Deformed foot;
  • They are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.

Medicare also requires the following:

  • A podiatrist or other qualified doctor must prescribe the shoes, and
  • A doctor or other qualified individual like a pedorthist, orthotist, or prosthetist must fit and provide the shoes to the beneficiary.

Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year, and the fitting of the shoes or inserts is covered in the Medicare payment for the shoes.

Insulin Pumps and the Insulin Used in the Pumps
Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions. If a beneficiary needs to use an insulin pump, their doctor will need to prescribe it. In the Original Medicare Plan, the beneficiary pays 20% of the Medicare-approved amount after the yearly Part B deductible. Medicare will pay 80% of the cost of the insulin pump. Medicare will also pay for the insulin that is used with the insulin pump.

Medicare Part B covers the cost of insulin pumps and the insulin used in the pumps. However, if the beneficiary injects their insulin with a needle (syringe), Medicare Part B does not cover the cost of the insulin, but the Medicare prescription drug benefit (Part D) covers the insulin and the supplies necessary to inject it. This includes syringes, needles, alcohol swabs and gauze. The Medicare Part D plan will cover the insulin and any other medications to treat diabetes at home as long as the beneficiary is on the Medicare Part D plan’s formulary. (Source:

Diabetes and Medicare Supplies – Part 1

Diabetes and Medicare Supplies – Part 1It can sometimes be confusing to know what exactly is covered under the U.S. Government’s Medicare program when it comes to diabetes. The Center for Medicare and Medicaid Services provides some details.


Medicare covers certain supplies if a beneficiary has Medicare Part B and has diabetes. These supplies include:

  • Blood glucose self-testing equipment and supplies;
  • Therapeutic shoes and inserts; and
  • Insulin pumps and the insulin used in the pumps

Blood Glucose Self-testing Equipment and Supplies

Blood glucose self-testing equipment and supplies are covered for all people with Medicare Part B who have diabetes. This includes those who use insulin and those who do not use insulin. These supplies include:

  • Blood glucose monitors;
  • Blood glucose test strips;
  • Lancet devices and lancets; and
  • Glucose control solutions for checking the accuracy of testing equipment and test strips.

Medicare Part B covers the same type of blood glucose testing supplies for people with diabetes whether or not they use insulin. However, the amount of supplies that are covered varies.

If the beneficiary

  • Uses insulin, they may be able to get up to 100 test strips and lancets every month, and 1 lancet device every 6 months.
  • Does not use insulin, they may be able to get 100 test strips and lancets every 3 months, and 1 lancet device every 6 months.

If a beneficiary’s doctor documents why it is medically necessary, Medicare will cover additional test strips and lancets for the beneficiary.

Medicare will only cover a beneficiary’s blood glucose self-testing equipment and supplies if they get a prescription from their doctor.

Their prescription should include the following information:

  • That they have diabetes;
  • What kind of blood glucose monitor they need and why they need it (i.e., if they need a special monitor because of vision problems, their doctor must explain that.);
  • Whether they use insulin; and
  • How often they should test their blood glucose.

A beneficiary needing blood glucose testing equipment and/or supplies:

  • Can order and pick up their supplies at their pharmacy;
  • Can order their supplies from a medical equipment supplier, but they will need a prescription from their doctor to place their order; and
  • Must ask for refills for their supplies.

Note: Medicare will not pay for any supplies not asked for, or for any supplies that were sent to a beneficiary automatically from suppliers. This includes blood glucose monitors, test strips, and lancets. Also, if a beneficiary goes to a pharmacy or supplier that is not enrolled in Medicare, Medicare will not pay. The beneficiary will have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers.

All Medicare-enrolled pharmacies and suppliers must submit claims for blood glucose monitor test strips. A beneficiary cannot submit a claim for blood glucose monitor test strips themselves. The beneficiary should make sure that the pharmacy or supplier accepts assignment for Medicare-covered supplies. If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly. Beneficiaries should only pay their coinsurance amount when they get their supply from their pharmacy or supplier for assigned claims. If a beneficiary’s pharmacy or supplier does not accept assignment, charges may be higher, and the beneficiary may pay more. They may also have to pay the entire charge at the time of service and wait for Medicare to send them its share of the cost. (Source:

Medicare and Diabetes Prevention

There is a greater cost involved in treating diabetes than preventing it. The U.S. Government realizes this so they have included prevention programs in their Medicare plan.

While this list isn’t complete it does take a look at prevention programs related very specifically to diabetes and related illnesses for those who participate in Medicare.

Cardiovascular Screenings
Helps detect conditions that may lead to a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels. No cost for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.

Diabetes Screenings
Checks for diabetes. These screenings are covered if you have any of the following risk factors: high blood pressure (hypertension), history of abnormal cholesterol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar (glucose). Tests are also covered if you answer yes to two or more of the following questions:

  • Are you age 65 or older?
  • Are you overweight?
  • Do you have a family history of diabetes (parents, siblings)?
  • Do you have a history of gestational diabetes (diabetes during pregnancy), or did you deliver a baby weighing more than 9 pounds?

Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. No cost for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.
Diabetes Self-Management Training

For people with diabetes. Your doctor or other health care provider must provide a written order. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

EKG Screening
Medicare covers a one-time screening EKG if you get a referral for it as a result of your one-time “Welcome to Medicare” physical exam. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. An EKG is also covered as a diagnostic test.
Flu Shots

Helps prevent influenza or flu virus. Covered once a flu season in the fall or winter. You need a flu shot for the current virus each year. No cost to you for the flu shot if the doctor accepts assignment for giving the shot.

Glaucoma Tests
Helps find the eye disease glaucoma. Covered once every 12 months for people at high risk for glaucoma. You are considered high risk for glaucoma if you have diabetes, a family history of glaucoma, are African-American and age 50 or older, or are Hispanic and age 65 or older. An eye doctor who is legally authorized by the state must do the tests. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Medical Nutrition Therapy Services
Medicare may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, or you have had a kidney transplant in the last 36 months, and your doctor refers you for the service. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Welcome to Medicare Physical Exam (one-time physical exam)
A one-time review of your health, and education and counseling about preventive services, including certain screenings, shots, and referrals for other care if needed. Medicare will cover this exam if you get it within the first 12 months you have Part B. You pay 20% of the Medicare-approved amount. When you make your appointment, let your doctor’s office know that you would like to schedule your “Welcome to Medicare” physical exam.

More information about these and other services can be found at the Medicare website

Pay for Performance: Medicare Hurting Diabetics

The idea of paying for high performing health care providers seems like a good idea, but new laws spelled out in the Health Care overhaul could mean that some diabetics on Medicare could find even limited services cut.

According to a press release in, “The planned nationwide implementation of institutional bonuses mandated under federal health care reform threatens to … [cause] hospitals in less-advantaged regions to lose funds to health care facilities in more affluent areas of the country, according to a study published in the academic journal PLoS Medicine.”

Researchers from New York University, Cornell University, and Harvard University say, “Pay-for-performance assumes that providers have adequate economic and human resources to perform, or improve their performance, within a short time frame. Yet the prevailing distribution of resources in the U.S. health care system makes it difficult for some providers to operate effectively as it is. Payment based on performance may worsen inequalities, as hospitals in under-resourced areas lose funds to their better-off counterparts, with the government acting as a sort of ‘reverse Robin Hood.’ ”

In essence what this policy does is potentially penalize rural health care centers because they don’t have the staff or patient volume to fairly compete with larger medical centers. When they can’t match performance the already struggling rural counterpart is penalized as extra Medicare funds are shifted to the high performance medical centers. The end result would appear to be a lack of quality care for rural residents – unless they are willing to travel to larger clinics in more urban areas. Often this is inconvenient and impractical.

The release explains more about how the new system would work, “Offering bonuses to doctors when they reach pre-determined targets, such as for the regularity of blood sugar checks for patients with diabetes, is a practice that has been adopted widely over the past decade by countries with rapidly aging populations and rising health costs, among them the UK, Australia and Taiwan. Pay-for-performance has also been used in the United States, albeit in a piecemeal fashion. Now, however, the U.S. is poised to evaluate hospitals in Medicare’s “Value Based Purchasing” (VBP) program, and, based on results, to reward those that improve, and reduce reimbursements for those that fail to show progress toward performance targets. The first wave of nationwide evaluation under this federally mandated effort, slated to begin in 2012, will focus on hospital performance on process-of-care measures for common conditions such as heart attack and pneumonia. Later, VBP will likely be extended to other metrics such as risk-adjusted patient death rates.”

This report does point out that there is a window of opportunity “to modify and improve upon the current version” of the new mandate before implementation in 2012. The study concludes, “”Holding providers accountable is not an unreasonable approach to quality improvement, but it must be done in a way that attends to the profound inequalities in local circumstances that shape life in the twenty-first century.”

Critics indicate that this plan could lead to health care rationing while others suggest the language should be addressed and will likely be changed. Those who view this as detrimental to Medicare patients in rural or under-served areas find the prospect less than ideal for patients who have come to rely on local care in familiar surroundings.

Health care remains a critical topic to all Americans, but the notion of decreased services for under-performing medical centers could potentially create significant gaps in care for Medicare patients struggling with diabetes.

Medicare and the Diabetic: Part D

In past articles we have covered the first three parts of Medicare coverage. This represents the final part in this government-based program.

Medicare prescription drug coverage (Part D) is available to everyone with Medicare. To get Medicare drug coverage, you must join a Medicare drug plan. Plans vary in cost and drugs covered.

Two plans offer Medicare prescription drug coverage:

  1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”

Who Can Get Medicare Drug Coverage?

To join a Medicare Prescription Drug Plan, you must have Medicare Part A and/or Part B. To get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B.

How to Join a Medicare drug plan

Once you choose a Medicare drug plan, you may be able to join by completing a paper application, calling the plan, enrolling on the plan’s Web site, or through the MPDPF LINK. You can also enroll by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Contact the specific plan you’re interested in to find out how to join. Medicare drug plans aren’t allowed to call you to enroll you in a plan. Call 1-800-MEDICARE to report a plan that does this. (Source:

The first year for Medicare Part D was 2006. That year 11 million people were expected to sign up to use this program. The actual number was 24 million.

According to government reports, “As of the end of year 2008, the average annual per beneficiary cost spending for Part D, reported by the Department of Health and Human Services, was $1,517, making the total expenditures of the program for 2008 $49.3 (billions). Projected net expenditures from 2009 through 2018 are estimated to be $727.3 billion.”

Interestingly statistics seem to suggest that since the implementation of Part D Medicare users have improved their willingness to follow their physician’s directions in taking medication. The usefulness of Medicare Part D has statistically proven that if an individual can afford to take the medication they will in fact take it.

According to Wikipedia, “As of 2008 there were 1,824 stand-alone Part D plans available. The number of available plans varied by region. The lowest was 27 (Alaska) and the highest was 63 (Pennsylvania & West Virginia). This allows participants to choose a plan that best meets their individual needs. Plans can choose to cover different drugs, or classes of drugs, at various co-pays, or choose not to cover some drugs at all. Medicare has made available an interactive online tool called the Prescription Drug Plan Finder that allows for comparison of drug availability and costs for all plans in a geographic area. The Prescription Drug Plan Finder can be used to perform a personalized or general search for plans; in either case, the tool allows one to enter a list of medications along with pharmacy preferences. The Plan Finder output includes the beneficiary’s total annual costs for each plan, along with a detailed breakdown of the plans’ monthly premiums, deductibles, and prices for each drug during each phase of the benefit design (initial coverage period, coverage gap, and catastrophic-coverage period).”