What is a Medicare Part D Prescription Drug Plan and do I need one?
There are two ways for people with Medicare to cover their precriptions, Part D plans and Medicare Advantage plans. A Part D plan will cover prescription drugs, but a Medicare Advantage plan may not cover all prescriptions. therefore, a Part D plan might be helpful. If you do choose a Medicare Advantage Plan make sure that your prescriptions are covered before signing up. Prescription drug coverage is an element of a Medicare Advantage plan. It can be a good choice if you have high medical costs and need a medications.
It is a requirement that you have a prescription drug coverage or you face a penalty for not having it of 1% per month of the national drug plan cost per month, for as long as you didn’t have coverage.
Plans can vary from insurer to insurer
Plans vary from insurer to insurer for Medicare Part-D prescription drug plans. They may cover different types of drugs, have a broader network of providers, or limit the number of co-pays. However, Medicare does not require any of the plans to cover the same drugs. This means that members should be aware of their options before signing up for a Medicare Part-D prescription drug plan, it is important to compare its features, cost, and benefits.
The standard benefit amount for is increasing every year. Depending on the insurance provider, Part-D plans may require a monthly premium or an annual deductible. There are some plans that charge no deductible at all. The maximum deductible amount is fixed by Medicare each year, and in 2022 the limit is $480. The copay amount varies by formulary tier and pharmacy.
Part-D prescription drug plans cover both brand-name and generic medications. Each plan will have a formulary that lists the drugs it covers. Formularies will differ from plan to plan, so be sure to read the details before signing up. You may find that your current pharmacy does not accept a plan that covers your new medications. You can also check with your doctor to see if you can get the same medications without paying more.
Plans can be used to supplement Original Medicare
Medicare plans can vary from year to year, and your choice of a plan can affect your finances. Supplemental plans are available that can help you pay out-of-pocket costs that Original Medicare does not cover. Medigap plans are privately owned insurance policies that can supplement Original Medicare by covering the remaining cost. Medicare Advantage Plans are best suited for seniors in good health and have no or low monthly premiums. If you get a supplement plan you will also need a Part D Prescription Drug plan as well. You might also want to look for a dental and vision plan, as Medicare doesn’t cover these and Supplement plans will only cover what Medicare covers.
A Supplement Plan pays up to 80% of the costs of emergency care outside the United States. However, you must enroll during your first sixty days of travel. These plans can also have a calendar-year deductible of around $250 and a maximum benefit of $50,000. Plan F and G pay the excess fees and charges that Medicare covers under Part B. Only plan F will pay the Part B deductable and only recipients who turned 65 before Jan. 2020 are elegible for Part F plans.
Depending on your situation, you will usually need both a supplement and prescription drug plan. Original Medicare covers certain costs, and a Medicare Supplement plan helps pay for the additional expenses. Original Medicare has a deductible and coinsurance. Supplemental plans help with original Medicare coverage by covering copayments, and out-of-pocket expenses, with the exception of the Medicare Part B deductible, which is $233 for 2022, except for Plan F. You can use one or the other, but you can’t have a Medicare Supplement plan and a Medicare Advantage plan. Some Medicare Advantage plans also allow you to choose an out-of-network provider.
Part D Prescription Drug Plans have a coverage gap
In most Medicare prescription drug plans, a “coverage gap” applies after a patient spends a certain amount on covered drugs. This amount may change every year. In general, you must spend $4,430 per year on covered drugs to enter the coverage gap. However, Extra Help for paying Part D costs does not trigger the coverage gap. As a result, you can get a much larger discount on prescription drugs.
For example, some Medicare Part D prescription drug plan sponsors offer multiple plans, each of which might be “best” for the beneficiary. These plans may be less comprehensive or have lower benefits. It is important to compare plans and understand their differences, as well as the coverage gaps they have. Hopefully, the Medicare Part D coverage gap will be eliminated once and for all in the future. LIS-eligibles (Low Income Subsidy) and dual eligibles may consider enrolling in a plan that meets their requirements.
There are several reasons why this coverage gap exists. Rising prescription drug costs, the rise in high-cost drugs, and the increasing cost of generics, among others, are all factors. Additionally, the Affordable Care Act introduced changes in the coverage gap to count manufacturer discounts on brand-name drugs as part of the cost. This change allows beneficiaries to save as much as 75% of the total cost of covered drugs.
Contact Us for help with your Medicare Questions
Willie Ware Aware Insurance Services 855-223-3023 bill@awareinsurance.com
