Medicare Part D Prescription Drug Insurance Coverage
You Need To Know This outline shares the basics of Medicare Part D only. Other important information you will need to make decisions about your Medicare coverage include: Medigap or Supplemental Insurance Plans that work with original Medicare Another option to Original Medicare called Medicare Health Plans or Medicare Advantage Plans For additional information go to: www.medicare.gov Contact PrimeWise at St. Elizabeth Healthcare (859)301-5999
This Outline Covers Medicare Part D Drug Coverage Medicare Part D Cost Eligibility Requirements Join / Switch Part D Plans Late Enrollment Penalty Comparing and Choosing Drug Plans Medicare Part D Extra Help Resources
Part D Medicare Drug Coverage Also called Prescription Drug Plan (PDP) All plans approved by Medicare (Centers for Medicare & Medicaid Services or CMS) Run by private insurance companies Available to everyone with Medicare Part A and/or Part B
Part D Medicare Drug Coverage Two sources of coverage: Individual Medicare Prescription Drug Plans (PDPs) Medicare Advantage Plans with Rx Coverage (MAPDs) not discussed in this presentation
Medicare Part D Plan Costs Initial Phase You pay the plan deductible, copays and/or copayments Plan will be keeping track of the total cost of the drug (your copay and their payment) Ends when the total cost of your prescriptions have reached $3,750
Medicare Part D Plan Costs Coverage Gap or Donut Hole Phase Phase lasts UNTIL your out-of-pocket cost for prescriptions have reached an additional $5,000 During the Gap or Donut Hole you will pay 44% of the cost of your Brand Name Drugs 35% of the cost of your Generic Drugs I
Medicare Part D Plan Costs Final Phase After the total out-of-pocket cost for your prescriptions have reached an additional $5,000 you exit the Donut Hole and enter the Final Phase or Catastrophic Coverage Phase During this final phase you will pay: 5% or less of the cost of all your drugs This occurs each calendar year
Part D Standard Benefit Costs Summary 2018 Example from 41017 2018 - National Monthly Plan Premium Range - $17.70 to $157.40 Deductible Range - $0 to $405 National Plan Premium Average $35.63 per month Nationally Not greater than $405 Initial Coverage Phase Total Drug Costs from $0 to $3,750 Plan determines amount beneficiary pays Coverage Gap (Donut Hole) Phase Beneficiary responsible for $5000 in additional out-of-pocket costs Beneficiary pays 44% of cost for brand and 35% for generics Final Phase - Catastrophic Coverage Phase after out-of-pocket costs exceed $5,000 Beneficiary pays 5% or small co-pays ($3.30/$8.25) whichever is greater
Part D Eligibility Part D Eligibility Requirements to Purchase Must have Medicare Part A and / or Part B Not have creditable drug coverage Examples of Creditable coverage: - Most employer group health plans - Employer or union retiree coverage - VA coverage - TRICARE - Federal Health Benefits
Part D Joining and Switching Join When first eligible at 65 or when enroll in Part B October 15 to December 7 (annual open enrollment) Switch October 15 to December 7 (annual open enrollment) Special Enrollment (such as move out of area, etc.)
Part D Late Enrollment Penalty If you do not enroll in either Part D Prescription Drug Plan or Medicare Advantage Plan with drug coverage When you are first eligible to do so and do not have another source of credible drug coverage There could be a late enrollment penalty added to your premium if you enroll at a later date.
Part D Medicare Drug Coverage Late Enrollment Penalty An Example Mrs. Jones enrolled in Medicare A & B June 1, 2015 Declined Part D / Had no creditable drug coverage Wants to enroll in Part D during 2017 open enrollment Part D effective date January 1, 2018 Mrs. Jones will have to pay a penalty for 30 months. No coverage from July 2015 to Dec. 2017 = 30 months 1% Penalty for each month = 30% (1% x 30 months = 30%) Here s the math.30 (30%) x $35.68 (2017 national base premium) = $10.68 Rounded to the nearest $0.10 = $10.70 Penalty is $10.70 a month added to Part D Premium lifetime.
Comparing and Choosing Plans Step 1 Gather information All prescription drugs, dosages and quantities Preferred pharmacy Medicare Card Print off Steps for Comparing Part D Drug Plans from the PrimeWise website.
Comparing and Choosing Plans Step 2 Use www.medicare.gov to enter your information and search for available plans Decide if purchasing a stand alone plan or if coverage will be part of an Advantage Plan Or call 1-800-MEDICARE Or contact PrimeWise for assistance
Comparing and Choosing Plans Step 3 Decide which plan is best for you and enroll Online, mail, or over the phone OR Call PrimeWise for assistance in comparing plans available (859) 301-5999
Comparing and Choosing Plans Step 4 Re-evaluate your Part D Prescription Drug Plan or your Advantage Plan EVERY YEAR During Open Enrollment October 15 December 7 Drugs you are taking, plan costs and coverage change each year
Help with Drug Costs Extra Help, also called Low Income Subsidy (LIS) People with lowest income and resources Pay no premiums or deductibles Have small or no copayments Those with slightly higher income and resources Have a reduced deductible Pay a little more out of pocket No coverage gap for people who qualify
Help with Drug Costs To apply for Extra Help contact: Social Security www.ssa.gov Call 1-800-772-1213 Ask for Application for help with Medicare Prescription Drug Plan Cost
Resources Medicare 1-800-633-4227 www.medicare.gov Social Security 1-800-772-1213 www.ssa.gov SHIP (State Health Insurance Program) 1-800-888-8189
Resources PrimeWise at St. Elizabeth Healthcare www.stelizabeth.com/primewise 859-301-5999 Provide Medicare classes frequently Individual appointments available Has Steps for Comparing Medicare Part D tool available Linking Adults 50+ to Health and Wellness
Thank You!aa We hope that you found this outline helpful Please take a moment to give us your feedback by clicking on the link below and answering our short survey. It will take less than 5 minutes. https://www.surveymonkey.com/r/y9dby5b Contact our office with any questions or concerns you may have. (859) 301-5999 primewise@stelizabeth.com