Medicare Part D

GPTKB entity

Statements (208)
Predicate Object
gptkbp:instanceOf gptkb:government_agency
gptkb:insurance
health insurance plan
healthcare payment system
gptkbp:administeredBy gptkb:Centers_for_Medicare_&_Medicaid_Services
private insurance companies
gptkbp:alsoKnownAs gptkb:Medicare_Part_C
gptkb:Hospital_Insurance
gptkbp:alternativeName Medicare_Advantage
Medicare_Advantage_Plan
Medicare_Advantage_plan
Medicare_Part_A
Medicare_payment_system
gptkbp:annualDeductible yes
gptkbp:annualEnrollmentPeriod October 15 to December 7
gptkbp:annualReview yes
gptkbp:appealsProcess yes
gptkbp:appliesTo gptkb:Medicare_Part_C
gptkb:Medicare_Part_B
Medicare Part D
gptkbp:approvedBy gptkb:Balanced_Budget_Act_of_1997
gptkbp:availableOn gptkb:United_States
Medicare beneficiaries
gptkbp:basisOfPayment fee-for-service
bundled payments
capitation
value-based payments
gptkbp:beneficiaryCostSharing coinsurance
copayments
deductibles
premiums
gptkbp:catastrophicCoverage yes
gptkbp:coinsurance yes
gptkbp:country gptkb:United_States
gptkbp:coverageGap yes
gptkbp:coverageGapKnownAs donut hole
gptkbp:covers outpatient services
prescription drugs
home health care
medically necessary services
outpatient prescription drugs
hospice care
medical services
inpatient hospital care
physician services
vision care
dental care
hearing care
hospital services
skilled nursing facility care
gptkbp:deductible yes
gptkbp:eligibility gptkb:Annual_Election_Period
gptkb:Open_Enrollment_Period
gptkb:Special_Enrollment_Period
Medicare beneficiaries
certain disabilities
age 65 and older
end-stage renal disease
gptkbp:enrollment voluntary
automatic for most people at age 65
over 30 million in 2023
gptkbp:enrollmentIn2023 over 30 million people
gptkbp:established 1983
gptkbp:establishedBy gptkb:Balanced_Budget_Act_of_1997
gptkb:Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act
gptkbp:excludes over-the-counter drugs
cosmetic drugs
drugs for weight loss or gain
drugs not approved by FDA
erectile dysfunction drugs (with some exceptions)
fertility drugs
vitamins and minerals (with some exceptions)
hospice care (covered by Original Medicare)
gptkbp:fundedBy gptkb:government
beneficiary premiums
federal government payments to private insurers
state payments
payroll taxes
gptkbp:includes gptkb:Diagnosis-Related_Group
gptkb:Inpatient_Prospective_Payment_System
gptkb:Outpatient_Prospective_Payment_System
Resource-Based Relative Value Scale
End-Stage Renal Disease Prospective Payment System
Home Health Prospective Payment System
Prospective Payment System
Skilled Nursing Facility Prospective Payment System
gptkbp:influenced private insurance payment models
gptkbp:limitation provider choice
gptkbp:lowIncomeAssistance Extra Help
gptkbp:marketShare2023 about 50% of Medicare beneficiaries
gptkbp:mayInclude gptkb:Health_Maintenance_Organization_plans
gptkb:Medical_Savings_Account_plans
gptkb:Preferred_Provider_Organization_plans
gptkb:Private_Fee-for-Service_plans
gptkb:Special_Needs_Plans
gptkb:HMO_plans
gptkb:PPO_plans
gptkb:Part_D_prescription_drug_coverage
telehealth services
annual changes in benefits and costs
care coordination services
chronic care management
different cost-sharing than Original Medicare
fitness benefits
high-deductible plan
home health care
meal delivery services
network restrictions
out-of-pocket maximum
over-the-counter drug benefits
prior authorization requirements
transportation benefits
zero-premium plan
disease management programs
different copayments
different deductibles
different drug formularies
different premiums
different provider networks
drug formularies
extra benefits
limited service area
limited service areas
provider networks
gptkbp:mustCover all services covered by Original Medicare
gptkbp:offeredBy private insurance companies
gptkbp:offers gptkb:Medical_Savings_Account_plans
gptkb:Private_Fee-for-Service_plans
gptkb:Special_Needs_Plans
gptkb:HMO_plans
gptkb:PPO_plans
telehealth services
chronic care management
extra benefits not covered by Original Medicare
fitness benefits
transportation benefits
wellness programs
over-the-counter allowances
gptkbp:openEnrollmentPeriod October 15 to December 7
gptkbp:partOf gptkb:Medicare
gptkbp:penalty yes
gptkbp:penaltyForLateEnrollment yes
gptkbp:planVariation cost-sharing structures
formularies
pharmacy networks
prior authorization requirements
quantity limits
step therapy requirements
gptkbp:policy gptkb:Medicare_Advantage_Prescription_Drug_plans
stand-alone prescription drug plans
gptkbp:premium usually free for most people
gptkbp:prohibits federal government from negotiating drug prices directly
gptkbp:provides Medicare Part A benefits
Medicare Part B benefits
Medicare Part D benefits
additional premiums
coinsurance
copayments
dental coverage
hearing coverage
prescription drug coverage
vision coverage
wellness programs
monthly premium
gptkbp:purpose control healthcare costs
standardize payments
gptkbp:regulates gptkb:United_States_federal_law
gptkb:Centers_for_Medicare_&_Medicaid_Services
private insurance companies
hospital reimbursement
physician reimbursement
post-acute care reimbursement
provider reimbursement
gptkbp:relatedTo gptkb:Social_Security_Act
gptkb:Affordable_Care_Act
Medicaid payment system
gptkbp:replacedBy gptkb:Medicare+Choice
gptkb:Medicare+Choice_plan
gptkbp:requires enrollment in Medicare Part A and Part B
network restrictions
prior authorization for some services
referrals for specialists
primary care physician
prior authorization for services
gptkbp:requiresEnrollmentIn gptkb:Medicare_Part_B
Medicare Part D
gptkbp:startDate 1966
2006
gptkbp:subject federal regulations
annual changes in benefits and costs
annual enrollment periods
star ratings by CMS
state regulations
Medicare rules and regulations
annual plan changes
annual contract renewal
star ratings system
gptkbp:targetAudience seniors
Medicare beneficiaries
people with disabilities
gptkbp:updated gptkb:legislation
CMS rulemaking
gptkbp:usedBy gptkb:Medicare_(United_States)
gptkbp:website https://www.medicare.gov/drug-coverage-part-d
gptkbp:bfsParent gptkb:Centene_Corporation
gptkb:Express_Scripts
gptkb:Medicare
gptkbp:bfsLayer 4