Medicare Part D – Details You Need to Know to Before You Enroll

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This video Explains how to find the BEST Medicare Part D drug plan for seniors when turning 65 or during the Annual Election Period. We highly recommend using the Medicare.gov plan finder tool here: or calling Medicare direct at 1-800-633-4227.
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1-844-528-8688

Part D is prescription drug coverage for Medicare beneficiaries who are enrolled in both Medicare Parts A and B. Although Part D is optional, you should enroll when you first become eligible or you will be subject to the Part D penalty which will have an impact on your rates, for as long as you are enrolled in a plan.

Part D is offered by private insurance companies and is not part of original Medicare. Plans are offered by service area and you must live in a service area to be eligible for a plan.

Medicare Part D Premiums — Premiums are paid monthly and range from $18.40 to over $75.00 with the national average for 2016 being $36.41.

Part D Deductible — The deductible is the amount you may be required to pay prior to your plan paying a share of prescription drugs. The amount of deductible and on what tiers, it is paid on will be determined by the Part D you choose.

Part D will also have copayments and/or coinsurance, this is the amount you pay at the pharmacy, and will be determined by what tier your prescription is.

Initial Coverage Limit — This amount is set annually by Medicare and will be the same for all plans. It is the amount both you and your plan will pay prior to you reaching the Part D coverage gap.

Medicare Part D Donut Hole or Gap — Is the coverage gap that you you will enter if you exceed the initial coverage limit of $3310.00 for 2016. This amount is the total spent by you AND the Insurance company combined.

Part D Catastrophic Coverage — Is reached after you alone (TrOOP) have spent a fixed amount in the Donut Hole, this amount is called True Out of Pocket. For 2016 the amount is $4850.00. During this phase you will pay very small copayments or coinsurance amounts for your drugs normally around %5.

Table of Contents:

00:00 – Introduction
00:24 – Slide 1
01:34 – Part D Late Enrollment Penalty
06:01 – Slide 7
07:00 – Slide 8
08:36 – Slide 9

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Loran Marmes
Medicare Solutions Team

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Medicare Part D – Details You Need to Know to Before You Enroll

 

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10 thoughts on “Medicare Part D – Details You Need to Know to Before You Enroll

  1. It used to be one could do this on the computer without calling Medicare. Why not anymore?! I have better things to do than be tied up on the phone. Some of my most exasperating calls have been to Medicare. I just don’t bother anymore!!!

  2. here we go….The 2019 Donut Hole or Coverage Gap begins when the total retail costs of your prescription medication purchases exceeds $3,820.00 and the Donut Hole continues until your retail drug costs exceed $7,653.75 (again, this is for 2019 — the Donut Hole limits change each year). The Donut Hole can also be said to end when your true out of pocket expense (or TrOOP) reaches $5,100.00. However, with the new Donut Hole Discount program,

    the discount you receive while in
    the Donut Hole is also counted toward your TrOOP.the discount you receive while in the Donut Hole is also counted
    toward your TrOOP.the discount you receive while in the Donut Hole is also
    counted toward your TrOOP.the discount you receive while in the Donut Hole is
    also counted toward your TrOOP.

      So if you purchase a brand-name medication with a $100 retail value and get a 75% discount, you still get credit for the portion of the discount paid by the Pharmaceutical Industry (50% of retail), plus the percentage of the retail cost you paid and combined, this amount is credited toward your annual TrOOP (or Donut Hole exit point).

  3. ….could you comment on why the Government/ plan/pharmacist doesnt continue to pay the same amount from after the initial deductible up to the catastrophic amount..and/or…Whats the real purpose/objective of a Donut Hole other than the obvious 45 to 58% cost to beneficiary?

    • If you are asking why the government set the donut hole, that is a question I can not answer. It is scheduled to be removed in 2020 and has been going down the last few years.

  4. It’s a shame the American government made the Medicare plan so complicated. And it’s a real shame private companies are allowed as an option. A 1 pay system would have been much better for the public.

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