We’re talking Medicare Part D in this video. This is one of the more confusing programs in Medicare, so if you have any questions, please call our office, 877-312-1414. We’re happy to help you.
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…
Medicare Part D
This is your prescription drug coverage in the Medicare program, Medicare Part D. It is similar to Medicare Part C in that Medicare itself doesn’t run any of the plans. They authorize private companies who meet a certain standard plan or better each year to sell Medicare Part D coverage directly to enrollees.
How to get Prescription Drug Coverage with Medicare
There are different ways of getting prescription drug coverage when you are on Medicare. One is through a Medicare Advantage plan that also includes Part D coverage. Those are known as MAPD plans.
The other way is through a standalone prescription drug plan, known as PDPs or Part D plans.
Part D Plan Restrictions to Watch For
There are some things to watch for in addition to the costs when you are evaluating Medicare Part D plans. The first is Prior Authorization. If your medication has a Prior Authorization restriction, it means that your doctor will need to communicate with the plan in order to be allowed to cover that prescription medication for you.
Another one is Step Therapy. If your prescription has a Step Therapy restriction on it that means that you will be required to take a, usually, lower cost medication first, and only move up, or step up, to the other medication if you fail on the less expensive medication.
Prior Authorization and the Step Therapy are definitely things that you want to avoid in Part D plans if you can.
The third restriction is Quantity Limits. For most people, this is not a big deal. On some medications, plans will have a Quantity Limit of 30 per month, or 60 per month, depending on the drug, and you have to stay under that limit. Any excess above their Quantity Limit will be solely your responsibility to pay for.
Medicare Part D Plan Costs
The costs to you in Medicare Part D plans are, first, that most of these plans have a monthly premium cost that you have to pay to be enrolled in the plan.
Some of them have deductibles that you need to pay out of pocket before the insurance company starts paying part of your drug cost.
Most also have co-pays, set amounts that you pay to fill a prescription. They also have coinsurance, which is a percentage of the drug cost that you need to pay to fill your prescriptions. It’s pretty similar in that regard to what we’re used to if we are on group insurance or individual insurance under age 65.
Coverage Gap/Donut Hole
Something that a lot of people get very worried about with Medicare Part D is the Coverage Gap or Donut Hole. First, it’s important to know that most people never reach the Coverage Gap. Also, the financial risk associated with the Coverage Gap has recently changed significantly.
Due to new regulations, it’s no longer the big financial risk that it used to be. The plans and the drug manufacturers are both responsible for part of the cost of your medications should you reach the Coverage Gap.
How to Find the Best Medicare Part D Plan for You
A good way to find a plan that might be good for you is to go to medicare.gov and use their calculator function. You can put in your zip code, all of your medications, and they will give you an estimate of how much each plan available in your zip code will cost you for the year.
Now because these are confusing plans, if you go to the medicare.gov calculator and you still have questions after that, definitely feel free to give our office a call, 877-312-1414, and we will answer any questions you have.
For most of our clients, we double check to make sure that the plan that they found on medicare.gov doesn’t have any pitfalls that they may have missed, and we’re happy to do that for all of our clients. If you have any questions reach out: send an email or give us a call at 877-312-1414. We’re always happy to hear from you!
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