Note: This information is included for educational purposes ONLY and no carrier-specific benefits or details are provided.
Please click here to learn more about Part D Prescription Drug Plans. Note that if you have or purchase a Medicare Advantage Plan, some plans (called "MAPD" plans) include prescription drug coverage while others do not.
If you purchase certain types of Medicare Advantage plans (e.g. HMO or PPO plans) without prescription drug coverage, you can not purchase a separate Part D plan. (If you purchase a PFFS plan without Part D coverage or a Medicare Savings plan, you CAN purchase a separate Part D plan. You can also purchase a Part D plan with a Medicare Supplement plan).
Federal law closely regulates how Part D Medicare Prescription Drug Plans can be marketed and sold. You must initiate the request for an agent to discuss a Part D Prescription Drug plan with you, and, if you desire a face-to-face meeting, must complete a Scope of Appointment Form (also called a Sales Appointment Confirmation Form or other name by some carriers) before an agent can meet with you to discuss a Part D Prescription Drug plan with you. Please call us to request an applicable Scope of Appointment form.
Unless you are eligible for a Special Election Period you must enroll in a Part D Prescription Drug plan during your Initial Coverage Election Period (the period beginning three months before and ending three months after your 65th birthday month-if your birthday is on the first day of the month your 65th birthday month is considered the first of the preceeding month) or during the Annual Election Period which runs from October 15-December 7 for a January 1 enrollment.
Although they must meet minimum Federal guidelines, Part D plans differ markedly between carriers, and one of the most important differences is which drugs are covered and which are not. This is a particularly important consideration for individuals who have been prescribed expensive medications. Each carrier provides a formulary that lists which drugs are covered under the offered plan and which copay tier the drug falls into. Subscribers should always check the formulary to determine if their drugs are covered--and at which copay--before purchasing a plan.
Medicare publishes a formulary finder that permits you to enter your medications and then lists the carriers that cover these medications in their formulary. Click here to access the formulary finder.
Federal law has changed how medications are covered in the coverage gap . The coverage gap begins in 2012 when all amounts, excluding premiums, paid by both the beneficiary and the carrier total $2,930 (note that some plans have voluntarily raised the $2,930 limit and the coverage gap starts at a higher amount) and ends when the beneficiary's true out-of-pocket costs (TrOOP) (including the coverage gap discount for generic and brand-name drugs) total $4,700. In 2012 you will pay 50% of the cost of brand-name drugs (you may also be required to pay a small dispensing fee) and 86% of the cost of generics. Some available Part D plans offer coverage in the coverage gap for certain medications.
Click here to find charts showing how the generic and brand-name drug discounts increase between 2011 and 2020.
You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there is a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage.
Starting January 1, 2011 Part D Prescription Drug Plan costs are adjusted if your income exceeds a certain level.
This additional cost will be deducted from your Social Security Check. Click here for additional details.
Besides Medicaid, there are four other ways to save on Medicare Part D prescription drug costs. Click here for instructions on how to apply for extra help online.
Disclaimer: This is not a complete listing of plans available in your service area. For a complete listing, please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048).Hours of operation are 24 hours a day, 7 days a week.
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