Medicare Part D: Prescription Drug Plan

Medicare Part D is an optional addition to Medicare that will increase your montly payment.

You have the option of picking the best plan for you from a variety of companies.

Below you will find info and links to help you pick the best plan to fit your pharmacutical needs.

 

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Part D Costs

How Much Does Medicare Part D Cost?

You can compare Medicare Part D plans by State by Clicking Here

Low Income

Where Can I Get Help Paying for Medicare Part D?

To see if you qualify for Extra Help Paying for Part D - Click Here

The "Doughnut Hole

What is the "Doughnut Hole" and how does it work?

Click Here for Your Prescription Drug Costs and Discounts During the Time You Are In the Doughnut Hole

Medicare Part D: Prescription Drug Plan

Medicare Part D: Your Drug Plan

What Does Part D Cover and How Does It Work?

Get Coverage | Penalties | Doughnut Hole | Financial Help | Catastrophic


Medicare Part D

 

Medicare Part D: Your Drug PlanMedicare offers prescription drug coverage to everyone with Medicare.

Even if you don’t take many prescriptions now, you should consider joining a Medicare drug plan.

If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.

Never Give Out Personal Information In Emails or Phone Calls. Medicare will not normally call or Email you.

IMPORTANT: In most cases, Medicare drug plans aren’t allowed to call you to enroll you in a plan.

If this happens, call 1-800-MEDICARE (1-800-633-4227) to report a plan that does this.

TTY users should call 1-877-486-2048. Don’t give your personal information to anyone who calls you to enroll in a plan.

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

List of Stores that Offer Free and Low Cost Prescription Drugs (Updated 2014)

 

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How To Join A "Part D" Prescription Drug Coverage Plan

 

couple signing up for Medicare Part DTo get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare.

Each plan can vary in cost and specific drugs covered.

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary).

Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.

A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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What If Your Plan Changes?

A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare.

If the change involves a drug you’re currently taking, your plan must do one of these:

  • Provide written notice to you at least 60 days prior to the date the change becomes effective.

  • At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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Medicare Part D Penalties

Late Sign Up Penalty and the "Doughnut Hole" Information

 

Medicare Part D penaltiesDon't worry, the cops aren't going to come and arrest you for Medicare violations.

But there are some monetary costs that can make a difference in what you pay each month for Medicare Part D.

The cost of the late enrollment penalty depends on how long you didn’t have creditable prescription drug coverage.

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Here's The Medicare Math

How Is the Penalty Calculated?


Currently, the late enrollment penalty is calculated by multiplying 1% of the
“national base beneficiary premium” ($32.42 in 2014) times the number of full, uncovered months that you were eligible but didn’t join a Medicare drug plan and went without other creditable prescription drug coverage.

The final amount is rounded to the nearest $.10 and added to your monthly premium.

Since the “national base beneficiary premium” may increase each year, the penalty amount may also increase each year.

You may have to pay this penalty for as long as you have a Medicare drug plan.

 

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An Example of The Late Enrollment Penalty


Example: Mrs. Jones didn’t join when she was first eligible— by May 1, 2010. She joined a Medicare drug plan with an effective date of January 1, 2014.

Since Mrs. Jones didn’t joinwhen she was first eligible and went without other creditable drug coverage for 43 months (June 2010–December 2013),
she’ll be charged a monthly penalty of $13.90 in 2014 ($32.42 X .01 = $.3242 X 43 = $13.90) in addition to her plan’s monthly premium.

After you join a Medicare drug plan, the plan will tell you if you
owe a penalty and what your premium will be.


What if I don’t agree with the penalty?


If you don’t agree with your late enrollment penalty, you can ask for
a review or reconsideration.

You’ll need to fill out a reconsideration request form (that your Medicare drug plan will send you), and you’ll have the chance to provide proof that supports your case, like information about previous creditable prescription drug coverage.

If you need help, call your plan. You can also contact your State Health Insurance Assistance Program (SHIP).

 

Click Here for the Phone Numbers in Your State

 

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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The "Doughnut Hole" And How It Will Affect

Your Part D Prescription Drug Plan Costs?

If you are on a fixed income please pay particular attention to this section.

 

Medicare Part D Doughnut Hole Coverage GapThe “Doughnut Hole” or gap, is a temporary limit based on how much you spend on prescription Drugs.

You will pay a copayment, and your plan pays its share for each covered drug until their combined amount (plus the deductible) reaches $2,850.

Once you spend $4,550 out-of-pocket costs for the year, your coverage gap ends.

From this point on you will only pay a small coinsurance or copayment for each covered drug until the end of the year.

When you enter the coverage gap, you pay 47.5% of the plan’s cost for covered brand-name drugs and 72% of the plan’s cost for covered generic drugs until you reach the end of the coverage gap.

Not everyone will enter the coverage gap because their drug costs won’t be high enough.

IMPORTANT: The drug plan premium and what you pay for drugs that aren’t covered don’t count toward getting you out of the coverage gap.

 

Click Here for Your Prescription Drug Costs and Discounts During the Time You Are In the Doughnut Hole

 

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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The following items all count toward you

getting out of the coverage gap:

      1. Your yearly deductible, coinsurance, and copayments
      2. The discount you get on covered brand-name drugs in the coverage gap
      3. What you pay in the coverage gap

Some plans offer additional coverage during the gap, like for generic drugs, but they may charge a higher monthly premium.

Check with the plan first to see if your drugs would be covered during the gap.

In addition to the discount on covered brand-name prescription drugs, there will be increasing coverage for drugs in the coverage gap each year until the gap closes in 2020.

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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Getting Help To Pay For Your Part D Plan

 

Financial help for Medicare Part DIMPORTANT: You may qualify for Extra Help in paying for your plan from your state.

Call Medicare’s Limited Income Newly Eligible Transition (NET)
Program at 1‑800‑783‑1307 for more information.

You may qualify for help paying for prescription drugs. There are three basic kinds of help:

1.) Extra Help from Medicare: People with limited income may qualify for Extra Help to pay for their prescription drug costs.

If you qualify, Medicare could pay up to 75 percent or more of your drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance.

Additionally, those who qualify will not have a coverage gap, or late enrollment penalty.

Many people are eligible and don’t even know it. To see if you qualify call:

1-800-Medicare (1-800-633-4227) - TTY users should call 1-877-486-2048; 24 hours a day/7 days a week or

 

Click Here for a web site with more information about getting Extra Help for low income seniors paying for Part D

 

The Social Security Office at 1-800-772- between 1 a.m. and 7 p.m., Monday through Friday - TTY users could call 1-800-325-0778 (applications), or Your State Medicaid Office (applications).

2.) Help from your State’s Pharmaceutical Assistance Programs (SPAPs): that helps people pay for prescription drugs based on their financial need, age, or medical condition.

To learn more about the program, check with your State Health Insurance Assistance Program.

3.) Prescription Cost-Sharing Assistance for Persons with HIV/AIDS: The AIDS Drug Assistance Program (ADAP) helps ensure that ADAP– eligible individuals living with HIV/AIDs have access to life-saving HIV medications.

Individuals must meet certain criteria, including proof of State residence and HIV status, low income as defined by State, and uninsured/under-insured status.

Medicare Part D prescription drugs that are also covered by ADAP qualify for prescription cost-sharing assistance through the ADAP program.

 

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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Catastrophic coverage


Catastrophic Coverage Medicare Part DOnce you get out of the coverage gap, you automatically get “catastrophic coverage.”

With catastrophic coverage, you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Note: If you get Extra Help paying for your plan from your state, you won’t have some of these costs.

Usually, the amount you pay for a covered prescription is for a month’s supply of a drug.

However, starting in 2014, you can request less than a month’s supply for most types of drugs.

Some examples of when you might do this would be if you’re trying a new medication that’s known to have significant side effects or you want to synchronize the refills for all your medications.

In these cases, the amount you pay is reduced based on the day’s supply you actually get.

Talk with your prescriber, because he or she will need to write you a prescription for this less than one-month supply.

 

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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The Medicare and You 2015 Booklet

 

Medicare and You Book 2015

You should have received the book on the left in your mailbox.

It's a complete explanation of how Medicare Part D works and all the changes that will be taking place in 2015.

We have documented the major changes on this page and our Medicare Part A and Part B Page as well as Medicare Part D also.

If you don't have the "Medicare and You 2015" booklet you can order or download it by CLICKING HERE.

 

You can find a plan with Medicare "Find a Plan" by Clicking Here

 

You can compare Medicare Part D plans by State by Clicking Here

 

Medicare Part D Costs - Medicare Prescription Drug Plans

 

To qualify for Extra Help Paying for Part D - Click Here

 

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Photo Credit
Some images courtesy of Ambro at FreeDigitalPhotos.net

 

 

 

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