Medicare Part D

The purpose of Medicare Part D is to offer coverage for prescription drug costs, which can be expensive. This coverage is provided by private insurance companies, who have contracted with and been approved by the government. If you already have Medicare Part A or Part B, you are eligible for Medicare Part D. If you’re interested in Medicare Part D, utilize our Comparison Tool to assist you in selecting a plan. You can even sign up right now on Medicare.com. If you’d prefer, you can phone one of our representatives to assist you with your enrollment. Dial 1-866-754-8910.

Each year there is a standard enrollment period during which you can change your plan. You can also enroll during that period as well. November 15 through December 31 is the annual enrollment period for Part D.

I’m not sure how to choose a plan. What should I look for?

  • Costs – The Medicare Plan Comparison Tool will help you easily and quickly line up costs on your selected plans to help you decide which plan will work best for you. This tool compares not only premiums, but deductibles and co-pays. You can also input the specific medications you take to get a full picture of your yearly out-of-pocket costs.
  • Physicians/Providers – If you have a Medicare Advantage Plan (such as an HMO or PPO) and your Part D is provided through that plan, then you want to ensure that your current providers are part of that plan. If your physician is considered out of network, there are often additional fees. Sometimes a referral is required for you to see that physician. These are concerns you want to investigate.
  • Travel Costs – Do you travel out of state? If so, you will want to know whether your Part D provided through your Medicare Advantage Plan will cover your medications in that particular state.

How much will this cost me in 2010?

  • Premium – Your Part D coverage will cost you a monthly premium. This cost will fluctuate depending on the plan you chose.
  • Deductible – Most plans require a yearly deductible. The average is $310. Typically, you will cover your medication expenses out of your own pocket until the total reaches $310. Once you have met your deductible, then you will only be responsible for 25% of the cost of your prescriptions thereafter until you reach the limit of $2830.
  • Initial Coverage Limit – Your coverage is limited to $2830. After you have exceeded this amount, the coverage on your prescriptions ends. After that point, you will pay for your prescription costs out of pocket. Once you have paid for $4550 of your own prescription drugs, you reach the Coverage Gap or Donut Hole. (The $4550 amount includes deductibles and coinsurance fees.)
  • Catastrophic Coverage – If your out of pocket expenses exceed $4550, you are now eligible for catastrophic coverage, which means that you will no longer cover your prescription medicine costs at 100%. You will be responsible for only 5% of your prescriptions costs for the rest of that year.

The Catastrophic Coverage period typically only impacts 4% of senior citizens covered by Medicare Part D. Those who most commonly qualify for the Coverage Gap do so paying for medications for these conditions:

  1. ACE Inhibitors
  2. Alzheimer’s
  3. Angiotensin Receptor Blockers
  4. Anti-depressants
  5. Oral Anti-Diabetics
  6. Osteoporosis
  7. Proton Pump Inhibitors
  8. Statins

Is there anything I can do to avoid falling into the Coverage Gap?

  • Select Medicare Part D plans that cover all of your medications.
  • Ask about are generic alternatives for your medications.
  • Use local pharmacies that provide your drugs at lower costs ($4.00 to $5.00).
  • Purchase your prescriptions from a mail-order pharmacy. (A 3 month supply of your medications can be obtained from a mail-order pharmacy for the cost of two co-payments.)

Is there any extra assistance for prescription costs?

If you want extra help with your prescription expenses, then you must join a Medicare drug plan. There is financial assistance available for deductibles, premiums, and co-pays. But you must qualify to receive assistance. Your eligibility depends upon your resources and income.

If you have the following conditions, you automatically qualify:

  • A state Medicaid program provides your coverafe.
  • Medicaid helps you pay your Medicare Part B premiums.
  • You receive Supplemental Security Income (SSI) benefits, but not Medicaid.

If you do not qualify under one of the above conditions, you can still apply for assistance.

  • Regardless of whether you qualify, you still need to join a Medicare drug plan to get the extra help.
  • If you qualify, and you don’t join a drug plan, then Medicare will enroll you in a Medicare drug plan.

Think you may qualify for extra help? Phone Social Security at 1-800-772-1213, or visit the Social Security website or apply in person at your State Medical Assistance (Medicaid) office.

Are there prescriptions that won’t be covered under the plan?

There is a short list of medications not covered by these plans. These medications are reffered to as “excluded drugs.” Some plans have opted to include them as an additional benefit, although the Centers for Medicare & Medicaid Services (CMS) does not require the plans to cover these drugs.

The categories of medications not required for coverage by the plans:

  • Barbiturates (seizure drugs)
  • Benzodiazepines (anxiety drugs)
  • Cosmetic (e.g., hair growth)
  • Cough and cold
  • Fertility
  • Nonprescription drugs
  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
  • Smoking Cessation (prescription smoking cessation drugs are covered)
  • Weight loss or weight gain