MEDICARE Part D Prescription
Drug Plan Options:
Medicare Part D is not that difficult to understand. There has been a lot of confusing information in the news about Part D Medicare. You will pay a monthly premium to the Insurance Company you select
for your coverage. Depending on the plan, you may have a $310 deductible before it starts to cover your prescriptions. The Initial coverage is paid at a minimum of 75% towards your prescriptions (some
plans may pay more or use co-pays). After your yearly drug costs reach $2,840, you reach the coverage gap also known as the "Donut Hole". Be aware that there are some "premium plans" which offer some coverage through the "Donut Hole". At the point where your yearly out of pocket drug costs reach $4,550 you will become eligible for catastrophic benefits. This amount includes co-pays and the deductible, if you have one. The Catastrophic Benefit pays a minimum of 95% of your prescriptions for the remainder of the year.
Please remember that if you select a Non-PFFS Medicare Advantage plan (i.e. Regence BlueShield MedAdvantage Plans), you will not need to look further than your carrier to find
your Medicare Part D plan. Your Medicare Advantage company will offer you
the Part D plans you can select. If you were to try and purchase a Medicare
Part D plan from another company, you would be dis-enrolled by your Medical
Advantage plan by CMS (Medicare). Another option would be to switch to a different
Medicare Advantage plan if you wished. This can also be done in the October
15th to December 7th enrollment period.
Medicare Prescription
Drug Coverage
People with limited income and resources who don't have Medicaid,
may qualify for extra help that may pay for about 95% of their drug costs.
Visit Extra Help For People with Limited Income and Resources for more information.
Because the way that Medicare drug coverage works depends on a person's current
coverage, Medicare has specific information available to help everyone, regardless
of their coverage. These resources include the CMS brochure What Medicare
Prescription Drug Coverage Means to You: A Guide to Getting Started and the
Medicare & You Handbook mailed to all people with Medicare this fall.
The brochure and other free Medicare publications are available by visiting
www.medicare.gov or calling 1-800-MEDICARE. People with Medicare should also
look for and review information from their current insurer about how their
current coverage will work with the Medicare prescription drug coverage.
To find out how much someone with Medicare can save with Medicare prescription
drug coverage, visit the Medicare Prescription Drug Plan Cost Estimator at www.medicare.gov . This information is also available by calling 1-800-MEDICARE.
Determining what matters most and reviewing plan options
Once someone decides that they want prescription drug coverage, they should
think about what matters most to them. There are a range of plan options available,
so they can focus on the kind of coverage they prefer. There are two ways
to get Medicare drug coverage. They can add drug coverage to the traditional
Medicare plan through a 'stand alone' prescription drug plan. Or they can
get drug coverage and the rest of their Medicare coverage through a Medicare
Advantage plan.
No matter what type of plan they choose, they can choose a plan that reflects
what they want in terms of cost, coverage and convenience.
- Cost: What a person with Medicare pays for the coverage, including
premiums, deductible, and payments for drugs.
- Coverage: What benefits are provided (like coverage in the 'coverage
gap' and other coverage enhancements), which drugs are covered and the rules
(like prior authorization) for getting those drugs.
- Convenience: Which pharmacies are part of the plan and whether
the plan has a mail-order option.
The Centers for Medicare & Medicaid Services has created an online resource, Landscape of Local Plans , located at www.medicare.gov , that helps people with Medicare find Medicare prescription drug plans by
state or Medicare Advantage plans with prescription drug coverage by county
that meet their needs based on cost, coverage, and convenience.
Choosing a plan
There are many ways to choose a plan. Some may rely on advice from people
they know or trust, or choose a plan they are already familiar with, or use
the Landscape of Local Plans located on www.medicare.gov to find a plan that meets their needs. All of the plan options must meet or
exceed Medicare's standards for coverage, including coverage for medically
necessary drugs.
If people want to make more specific plan comparisons based on what matters
to them, they can get personalized information from the Medicare Prescription
Drug Plan Finder . The Medicare Prescription Drug Plan Finder can be accessed
at www.medicare.gov or through a customer service representative at 1-800-MEDICARE,
or through the many organizations working with Medicare to help people take
advantage of the new drug coverage.
Enroll
- You can join when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability,
you can join from three months before to three months after your 25th month of cash disability payments.
- If you didn't join when you were first eligible, you can join between October
15th to December 7th of each year. Your coverage will begin on January 1 of the following year. Generally, your next opportunity to make a change will be between October
15th to December 7th of each year.
- Late Enrollment Penalty (LEP) If you don't join a Medicare prescription drug plan when you're first eligible, you must wait until your next enrollment opportunity to join a drug plan, and you may have to pay a higher premium because of a late enrollment penalty.
- If you are assessed a late enrollment penalty:
- The amount will be billed or deducted with your drug plan premium.
- You will be charged a penalty for as long as you continue to have Medicare prescription drug coverage.
- It will change on an annual basis.
Note: In certain
situations, you may be able to join a Medicare Advantage plan or Medicare Prescription Drug Plan at other times. For example, if you:
- Move out of your plan's service area
- Have both Medicare and Medicaid
- Live in, or move into or out of an institution (such as a nursing home)
- Have creditable prescription drug coverage and that coverage ends
- Lost employer coverage or your plan coverage is no longer
available in your area
WHAT IS CREDITABLE COVERAGE?
Medicare beneficiaries will have the opportunity to receive subsidized prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period. [more information]
Medicare Prescription Drug Coverage
People with limited income and resources who don't have Medicaid,
may qualify for extra help that may pay for about 95% of their drug costs.
Visit for more information.
Because the way that Medicare drug coverage works depends on a person's current
coverage, Medicare has specific information available to help everyone, regardless
of their coverage. These resources include the CMS brochure What Medicare
Prescription Drug Coverage Means to You: A Guide to Getting Started and the
Medicare & You Handbook mailed to all people with Medicare this fall.
The brochure and other free Medicare publications are available by visiting
www.medicare.gov or calling 1-800-MEDICARE. People with Medicare should also
look for and review information from their current insurer about how their
current coverage will work with the Medicare prescription drug coverage.
To find out how much someone with Medicare can save with Medicare prescription
drug coverage, visit the Medicare Prescription Drug Plan Cost Estimator at . This information is also available by calling 1-800-MEDICARE.
Determining what matters most and reviewing plan options
Once someone decides that they want prescription drug coverage, they should
think about what matters most to them. There are a range of plan options available,
so they can focus on the kind of coverage they prefer. There are two ways
to get Medicare drug coverage. They can add drug coverage to the traditional
Medicare plan through a 'stand alone' prescription drug plan. Or they can
get drug coverage and the rest of their Medicare coverage through a Medicare
Advantage plan.
No matter what type of plan they choose, they can choose a plan that reflects
what they want in terms of cost, coverage and convenience.
- Cost: What a person with Medicare pays for the coverage, including
premiums, deductible, and payments for drugs.
- Coverage: What benefits are provided (like coverage in the 'coverage
gap' and other coverage enhancements), which drugs are covered and the rules
(like prior authorization) for getting those drugs.
- Convenience: Which pharmacies are part of the plan and whether
the plan has a mail-order option.
The Centers for Medicare & Medicaid Services has created an online resource, located at , that helps people with Medicare find Medicare prescription drug plans by
state or Medicare Advantage plans with prescription drug coverage by county
that meet their needs based on cost, coverage, and convenience.
Choosing a plan
There are many ways to choose a plan. Some may rely on advice from people
they know or trust, or choose a plan they are already familiar with, or use tool located on to find a plan that meets their needs. All of the plan options must meet or
exceed Medicare's standards for coverage, including coverage for medically
necessary drugs.
If people want to make more specific plan comparisons based on what matters
to them, they can get personalized information from the Medicare Prescription
Drug Plan Finder . The Medicare Prescription Drug Plan Finder can be accessed
at www.medicare.gov or through a customer service representative at 1-800-MEDICARE,
or through the many organizations working with Medicare to help people take
advantage of the new drug coverage.
Enroll
- You can join when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability,
you can join from three months before to three months after your 25th month of cash disability payments.
- If you didn't join when you were first eligible, you can join between October
15th to December 7th of each year. Your coverage will begin on January 1 of the following year. Generally, your next opportunity to make a change will be between October
15th to December 7th of each year.
- Late Enrollment Penalty (LEP) If you don't join a Medicare prescription drug plan when you're first eligible, you must wait until your next enrollment opportunity to join a drug plan, and you may have to pay a higher premium because of a late enrollment penalty.
- If you are assessed a late enrollment penalty:
- The amount will be billed or deducted with your drug plan premium.
- You will be charged a penalty for as long as you continue to have Medicare prescription drug coverage.
- It will change on an annual basis.
Note: In certain
situations, you may be able to join a Medicare Advantage plan or Medicare Prescription Drug Plan at other times. For example, if you:
- Move out of your plan's service area
- Have both Medicare and Medicaid
- Live in, or move into or out of an institution (such as a nursing home)
- Have creditable prescription drug coverage and that coverage ends
- Lost employer coverage or your plan coverage is no longer
available in your area
WHAT IS CREDITABLE COVERAGE?
Medicare beneficiaries will have the opportunity to receive subsidized prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period. []
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