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Prescription Drug Coverage 

 

 

What is Prescription Drug Plan?

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A Medicare Prescription Drug Plan, often referred to as Medicare Part D, is a standalone insurance plan offered by private insurance companies that helps Medicare beneficiaries pay for prescription drugs. Medicare Part D is designed to provide coverage for both brand-name and generic prescription medications, and it is available to individuals who are eligible for Medicare Part A and/or enrolled in Medicare Part B.

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Here are some key features of Medicare Prescription Drug Plans:

 

  • Coverage of Prescription Drugs: Medicare Part D plans provide coverage for a wide range of prescription medications, including those used to treat chronic conditions, acute illnesses, and preventive care. Covered drugs are listed on the plan's formulary, which is a list of medications covered by the plan.

 

  • Monthly Premiums: Beneficiaries enrolled in a Medicare Part D plan typically pay a monthly premium to the insurance company providing the plan. Premium amounts can vary depending on the specific plan, its coverage, and the beneficiaries location. Some plans may have a $0 premium option, while others may have higher monthly premiums.

 

  • Annual Deductible: Most Medicare Part D plans have an annual deductible that beneficiaries must pay before the plan begins to cover the cost of prescription medications. Deductible amounts can vary between plans, and some plans may offer a $0 deductible option.

 

  • Cost Sharing: In addition to the monthly premium and deductible, beneficiaries enrolled in a Medicare Part D plan typically pay cost-sharing amounts for their prescription medications. This can include copayments or coinsurance for each prescription filled, as well as a percentage of the medication's cost (coinsurance) after the deductible has been met.

 

  • Coverage Gap (Donut Hole): Medicare Part D plans include a coverage gap, also known as the "donut hole" which is a temporary limit on what the plan will cover for prescription drugs. Once total drug costs (including what the plan pays and what the beneficiary pays) reach a certain threshold, beneficiaries enter the coverage gap and are responsible for a higher percentage of their drug costs until they reach catastrophic coverage. The Affordable Care Act (ACA) made changes to the coverage gap, gradually closing it by 2020.

 

  • Catastrophic Coverage: Once beneficiaries reach the catastrophic coverage threshold, they pay only a small coinsurance or copayment amount for covered medications for the rest of the year.

 

  • Open Enrollment Period: Medicare beneficiaries can generally enroll in or make changes to their Medicare Part D coverage during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. Beneficiaries may also have other opportunities to enroll or make changes to their Part D coverage during special enrollment periods. Medicare Part D plans offer beneficiaries access to affordable prescription drug coverage and help them manage the cost of their medications. It's essential for beneficiaries to carefully review plan options each year during the annual enrollment period to ensure they are enrolled in a plan that best meets their medication needs and budget.

This site is not affiliated with or endorsed by the government or federal Medicare program. 

Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan in your area. Please contact medicare.gov or 1-800-Medicare to get information on all your options.

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