This manual provides an introduction to the Medicare Prescription Drug (Part D) program, including eligibility, enrollment, coverage issues, costs, the Low-Income Subsidy program, and related programs, such as VA drug coverage. It is one of three HAP Medicare training manuals in a series that also contains manuals on the Medicare Basics and Medicare Advantage programs. Updated in January 2010.

Table of Contents

Overview of Medicare Part D

Types of Drug Plans

The Two Main Categories
Plan Variations

Eligibility and Enrollment

Eligibility For Enrollment
Deciding to Enroll in a Part D Plan
How to Select a Plan
Enrollment Periods
How to Enroll
Disenrolling and Switching

Relationship to Medicare Advantage

Introduction
Types of Medicare Advantage (MA) Plans
MA Plans and Part D

Costs and Prices

Beneficiary Cost-Sharing
True Out-of-Pocket (TrOOP) Costs
Late Enrollment Penalty

Help for Low-Income Beneficiaries

Eligibility
Levels of Low-Income Subsidy
Applying for Low-Income Subsidy
Eligible for Low-Income Subsidy
Medicaid's Role with Non-Part D Drugs
Redeterminations and Redeeming
Part D Plan Reassignment by CMS
Prescription Drug Assistance Programs and Medicare Part D

Access to Drugs and Formularies

Pharmacy Networks
Formularies
Cost-Containment Strategies
Medication Therapy Management Programs (MTMPs)
Transition Policies

Grievances, Coverage Determinations, and Appeals

Grievances
Coverage Determinations (Including Exceptions)
Appeals

Marketing

Overview
Marketing Materials
Marketing Review
Special Guidelines
Promotional Activities
Marketing Rules for Employer/Union Sponsored
Group Plans for Retirees

Resources

Appendices
NOTE: If you have trouble accessing links in the Appendices, please copy and paste the link into your browser to navigate directly to the resource.

PDF of the complete, 99-page guide

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