Medicare Part D helps pay for prescription drugs, but it is not added automatically when you enroll in Medicare. Medicare Part D is a voluntary program and is purchased through a private insurance company. However, if you delay purchasing a Medicare Part D plan there will be a penalty assessed if you choose to enroll in a Part D plan later, unless there is an exception.
Are My Drugs Covered?
It depends. The federal government has created guidelines on the type of prescription drugs that must be covered, but that does not necessarily mean your prescriptions are covered. Each insurance company has a different formulary (list of drugs they cover), depending on which plan you enroll in and the area you live. The cost of the plans also vary.
Medicare Colorado agents will review prescriptions, benefits, and the cost of plans prior to enrolling you in a Part D Drug Plan. We want to ensure you choose the right plan for your needs.
How Do I Enroll in a Part D Plan?
You have two choices when enrolling in a Part D Plan. You can enroll in a stand-alone Part D prescription plan or a Medicare Advantage plan. Most Medicare Advantage Plans have Part D included in the plan, which allow the beneficiary to use the same card for prescription drugs, hospital care, and doctor appointments. A stand-alone Part D plan is typically purchased as an addition to Original Medicare and a Medicare Supplement Plan.
Which Pharmacies May I Use?
Again, it depends. Each drug plan designates which pharmacies can be used in their network. If you travel often you may want to consider a plan that has nationwide coverage. Many plans offer mail-order prescriptions, as well. Our agents will fully explain the benefits and pharmacy network prior to enrolling you in a plan to ensure you chose the right plan for your needs.
What is the Coverage Gap (Donut Hole)?
In 2011, the coverage gap in a Medicare Part D plan begins after you consume $2,840 worth of prescription drugs through your plan. At this point, you will pay 50% of the cost for most of your drugs. To get out of the coverage gap you need to spend $4,550 out-of-pocket in a calendar year (this includes the 50% paid by drug companies inside the coverage gap). When you get out of the coverage gap, most Part D plans will pay 95% of the cost of the drugs while you pay 5%.
The Affordable Care Act
The Affordable Care Act includes provisions to close the Medicare Part D prescription drug coverage gap to make prescription drugs more affordable for people with Medicare. The coverage gap will be closed by 2020.
For 2011, the cost of most prescription drugs will be reduced by 50% during the coverage gap, minus the dispensing fee. For example, if you reach the coverage gap in 2011, you will pay 50% of the cost of your drugs and the drug maker will pay the other 50% (minus the cost to dispense the drug).
The list of participating prescription drugs can be found here: http://www.cms.gov/PrescriptionDrugCovGenIn/.
That’s OK. Medicare Colorado agents are here to help you every step along the way. We are licensed, certified, and trained to answer all of your questions regarding your Part D prescription drug needs. Come to a seminar or schedule an in-home appointment.