LEARN ABOUT MEDICARE’S PRESCRIPTION DRUG PROGRAM
Prescription coverage is optional and is called Medicare Part D, this is where Medicare will help pay for your prescriptions when you enroll in this plan. There a few different plans which will have different coverage options. There is also an ability to qualify for extra help which can help cover the cost of Medicare Part D.
Your cost of your drug plan will depend on the drugs you take, the plan chosen, using an in-network pharmacy, if the drugs are a part of your plan, and if you can get extra help. Also if you decide to enroll in Part D at a later time it can result in a late enrollment penalty, there are a few circumstance where the late penalty is not applicable.
Each drug plan has a specific coverage, so make sure to talk to our specialists to make sure you get the right coverage. There are some things to watch for when choosing Medicare drug coverage. Here are a few examples like which specific drugs you are currently taking, do you use a lot of generic prescriptions, need coverage of expensive drugs.
If your Medicare Part D plan has a deductible, then you must meet your deductible first which is your out-of-pocket amount before Medicare will pay for your prescriptions. There are different deductible options, including a $0 deductible. The $0 deductible has the lowest overall costs per year.
There is also Copayments and Coinsurance. If you have a copayment then you will have a fixed price you will pay for your prescriptions. An example would be a certain amount for generic prescriptions, preferred prescriptions, and non-preferred prescriptions. If you have coinsurance then it will be a certain percentage of your prescription. There are different tiers that will dictate what your percentage costs will be. Selecting the plan with low copay or coinsurance will have the lowest overall costs per year. It is important to check the costs of all medications that you are currently taking to make sure you get the right coverage.
So what do the copay tiers consists of? Each plan has their own copay or coinsurance amount and every medication can be in a different tier which equates to different copay amounts, this is why it is important to call Absolute Insurance to make sure we get you the right medication coverage and that you understand what the costs will be for each medication.
What is a coverage gap?
This where your Part D plan will stop paying for your prescriptions. The coverage gap currently includes 37% on generic prescriptions and 75% on brand name prescriptions. This coverage gap begins when your total drug costs for the year reaches over $3820. If your total drug costs for the year will be over $3820 you will need to consider a plan that can help cover you during the coverage gap.
When your gap coverage goes above $5100 out of pocket and $7654 total drug cost, then you get catastrophic coverage which will cover 95% or more of your drugs for the rest of the year and there is no longer a cap amount after this coverage takes place.
Every month you purchase drugs you will get a report to help you keep track of your current out-of-pocket costs. Medicare has two group classifications for drug costs. One is your “true” out-of-expenses costs and this will count towards your catastrophic costs. Second group is any other drugs you have purchased and these will not count towards your catastrophic amount.
You are probably wondering what counts as your “true” out-of-pocket cost, this includes any money that you paid for covered drugs which will comprise of copays and amount payed toward your deductibles. What is also included are the amount the drug manufactures pay for any brand name drugs while you are in the gap coverage. You will still get credit if you get help from others such as family, friends, charity, drug company assistant programs, and more.
So now you are probably wondering what costs will not count towards your out-of-pocket costs. Here are some areas that don’t count towards your out-of-pocket costs over the counter drugs, drugs that are not covered under you plans network or on your drugs list, if you have additional employee coverage that helps pay a certain amount for you.
Before you make a decision, Absolute Insurance will help you understand how Part D can help you or work with your current coverage from an employer or union insurance.