MEDICARE PART D DRUG PLAN – What Is It? How Does It Work?

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You can get Medicare Part D coverage if you're enrolled in Original Medicare. You will find a variety of different programs. Therefore, your monthly plan premium and out-of-pocket expenses for your prescription drugs will vary from plan to plan.

Every Medicare Drug Plan has a formulary which is a list of covered drugs. The formularies vary among programs. The formulary may change at any time. You will receive notice from your plan when necessary. The formulary is then broken down into cost tiers.

Finally, be aware that your plan may change its formulary. You want to review the Annual Notice of Change that the program sends you every fall. You want to make sure it still covers your prescriptions in the coming year. Your coverage typically works like this:

A. Your Drug Plan will have an annual deductible. You pay 100% of your prescription purchases until your deductible is met.

B. After you satisfy your deductible, you’ll pay your share of the prescription costs according to benefits of your plan. Your share, which you pay to the pharmacy when you pick up your prescriptions, could be either a flat amount or a percentage of the total sum.

C. After you’ve paid a maximum amount out of your own pocket for your prescriptions, you get into "catastrophic coverage." This means for the rest of that year, you would only pay a small copay or coinsurance amount for your prescriptions.

Talk to your doctor to ensure you are taking the lowest cost medications available to you. Accurate coverage may vary from plan to plan, so read your statement of benefits carefully.

You’ve probably heard about the "donut hole." Let me describe it, so you understand how it works. After your Medicare Part D coverage has paid a certain amount for your prescriptions, you pay all costs yourself, up to the yearly limit. This limit on what your Drug Plan will pay for covered drugs is the “donut hole.”

New federal legislation will reduce the gap over the next several years to make drugs more affordable. There will be savings in the “donut hole” each year through 2020, then it closes completely.

You should review your Part D drug plan every year during the Annual Election Period, October 15th to December 7th. You need to update the medications you’re taking every year.

What do you do now? Simple! As a qualified broker, we specialize in Original Medicare and helping you with your Medicare supplement and drug plans. We have both the professional knowledge, experience, and follow-up to help you find the right options for you. Call us today at 1-800-825-2919.

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MEDICARE PART D DRUG PLAN – What Is It? How Does It Work?

 

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