Part D plans are prescription coverage for seniors with Medicare or Medicare Advantage. We’ve broken down how prescription drug coverage works for you now that you’re over 65.
Two Ways to Get Drug Coverage
1) Medicare Prescription Drug Plan (Part D). You get these drug plans through Original Medicare. If you have a Medigap plan you’ll need to enroll in a separate drug plan, as new Medigap plans do not include prescription coverage. You may need to enroll in a drug plan with some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2) Medicare Advantage Plan (Part C) or other Medicare health plan that offers Medicare prescription drug coverage. You replace Original Medicare’s Part A and B with this plan, and many times prescription drug coverage is offered. You may need to enroll separately if your plan does not offer Rx coverage.
What Prescription Plans Cover
Each Rx plan has its own drug formulary (drugs the plans cover). Most plans place drugs in tiers, with each tier having a different cost. There are exceptions to your cost such as if your prescriber (doctor) feels that a higher tiered drug will work better for you than a lower tiered drug, you may receive the higher tiered drug at a lower copay.
Part D Costs
Generally your premium is $31.16 per month, however if you get a Medicare Advantage plan your premium is bundled in.
Medicare Part D Donut-Hole
This is a gap in coverage after you reach $2,970 (a combined spending total from you and Medicare) you reach the donut-hole. During this time you will pay 47.5% of brand name drugs, and 79% of generic drugs in 2013 (25% by 2020). However, what you pay for brand name drugs in your coverage gap, as well as the drug companies’ discounts, will count towards your out-of-pocket costs to help you get out of the donut-hole.
For example if you buy a drug that is $60 plus a dispensing fee of $2, you would pay $29.45 for the drug BUT $59.45 will count towards your out-of-pocket costs for your brand name drugs. During the coverage gap, this does not apply to generic drugs. Only what you pay toward generic drugs count toward your out-of-pocket costs.
For further questions or help enrolling please call 800-930-7956 or contact Senior65.