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Part D Prescription Drug Plans

Part D Prescription Drug Plans


The Medicare Drug plan you select will come with its own list of drugs covered by the plan. This is usually known as a formulary, and consists of different “tiers” of drugs, depending on the costs. Cheaper drugs fall in lower tiers, whereas a drug in a higher tier may be costlier.

In case you have been prescribed a drug that’s on a higher tier, you or your doctor could request your plan provider for an exception to help reduce copayment.

Medicare drug plan providers have full authority to make any changes to their formulary at any time of the year, given the changes are within the guidelines set by Medicare. In case the change directly relates to a drug you’ve been prescribed, you may expect your plan to do any of the following few things:

  • Written notice at least 60 days before the change is to take effect.
  • Provide written notice of the change as well as a 2 month supply of the drug under the same rules as before the change at the time of refill request.

How can Part D help me?

  • A Part D Prescription Drug Plan helps with management and coverage of prescription-drug dues and comes into effect since three months before your 65th
  • If you enroll more than three months after your 65thbirthday, you may be charged a permanent premium surcharge, especially if you don’t already have drug coverage from a secondary source, such as a retiree plan.
  • For individuals that are enrolled in any Medical Advantage Plan that also offers drug coverage, or a standalone Part D plan, the open-enrollment period allows you to switch plans with no repercussions. This period usually lasts from the 15thof October to the 7th of December annually.

Making the Best of It

The “donut hole” refers to the coverage gap most prescription drug plans have. The donut hole is the temporary limit most plans have on drug coverage. If you have already paid a certain amount on drugs present in the formulary, ($3,750 for the year 2018) you enter the donut hole which requires you to pay no more than 35% for the prescription drugs your plan covers.

Medicare owners who also get Extra Help paying Part D costs never reach the donut hole. Whether you buy your drugs at a pharmacy or order them online, your plan will offer you discounts on that specific drug, depending upon their contract with the pharmacy.

85% of prices in 2018 will be considered to be out-of-pocket costs. The following are not included:

  • Plan payments toward drug prices (15% in 2018)
  • Plan payments toward dispensing fees (65% in 2018)

Choosing a plan

If you have recently started taking new drugs, an annual review of your Part D coverage can provide some major benefits.

  • Begin your journey at gov,which offers most of the basic information about Part D. The Medicare Part D Plan Finder, by allowing you to view side-by-side comparisons of coverage benefits in your area, helps you choose the best drug plan according to your needs. The plan finder will also help you see approximate monthly out-of-pocket costs for the year.

If you need more assistance regarding the above, call us!

Getting Financial Aid

If your yearly income is less than USD 17,820, financial resources below USD 13,640 or if have a joint income of under USD 27,250 (in case you’re married), you may be applicable for financial aid. Here, Medicare covers part of your Part D premium payments and individual drug costs.

Instructions: Extra Help program application – Download.

Source: www.medicare.gov

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