Medicare Part D: What Pharmacy Techs Should Know

Medicare Part D Basics

Medicare Part D is the optional prescription drug benefit available to Medicare beneficiaries. It is provided through private insurance companies approved by Medicare. Each plan has its own formulary, premium, and cost-sharing structure.

Part D has four coverage phases: the deductible phase, the initial coverage phase, the coverage gap (formerly called the "donut hole"), and catastrophic coverage. Understanding these phases helps pharmacy technicians explain costs to patients.

The Coverage Gap

The coverage gap begins after the patient and plan have spent a combined amount on drugs (the initial coverage limit). During the gap, patients pay a higher percentage of drug costs. The Affordable Care Act has been closing this gap, but patients may still pay more during this phase.

Once the patient's true out-of-pocket spending reaches the catastrophic coverage threshold, they pay only a small copay or coinsurance for the rest of the year.

PTCB Exam Preparation

Medicare Part D questions test your knowledge of government insurance programs. Study these phases with our flashcards and practice with PTCB mini exams.