What You Should Know about Part D
Medicare Plan D coverage provides recipients with prescription drug coverage. original Medicare and Medigap do not cover medication. Medicare Advantage Plans may include prescription drug plans, as well as additional benefits depending on the plan. Advantage Plans are private health care supplemental insurance plans specifically geared for seniors who want more from their Medicare coverage. For seniors who have dual coverage from Medicare and Medicaid, they'll automatically get comprehensive prescription drug coverage from Medicare starting January 1, 2008.
The Annual Enrollment Period for Medicare Plan D is from November 15 to December 31. Plans change from year to year, so beneficiaries should consider all options before enrolling. Before choosing a plan, you may want to take into consideration which pharmacies are approved and mail order options. There may be certain rules like pre-authorization with medications.
The plan's formulary is also something to take into consideration. That ""Formulary"" is a list of covered drugs approved by the plan. If a certain medication is not on the formulary; the person has to pay the full amount of the prescription. After the initial enrollment, your plan will remain the same every year if no changes are selected.
Private Prescription Plans
Private prescription plans must be at least the same standard benefit as from Medicare. The standard benefit includes a deductible of. Medicare does not mandate a set premium amount. These costs and the list of covered medications vary from plan to plan and from region to region. Beneficiaries should take time to review all options available to them taking into consideration their current and anticipated needs and financial resources.
After the deductible has been met, beneficiaries pay 25% of covered Plan D prescription drugs up to $2,510. Beneficiaries must pay the full costs of drugs if they exceed $2,510. Once this limit has been met, beneficiaries must pay the full cost of prescriptions. This is known as the Coverage Gap. If out-of-pocket expenses on formulary drugs reach $4,050 including deductibles and coinsurance, beneficiaries reach the Catastrophic Coverage Benefit. Beneficiaries entitled to Catastrophic Coverage pay $2.25 for a generic or preferred drugs; $5.60 for other drugs, or a flat 5% coinsurance, whichever is greater. The out-of-pocket amount is calculated annually and starts over every January.
*You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
OR
- The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or Your State Medicaid Office.