Medicare supplement and part D Quotes
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Part D Prescription Drug Plans

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 Cost (1876) 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 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 Open Enrollment Period (formerly called 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 for 2015 begins when all amounts, excluding premiums, paid  by BOTH the beneficiary and the insurance carrier total $2,960 (note that some plans voluntarily raise the $2,960 limit and start the coverage gap at a higher amount) and ends when the beneficiary's true out-of-pocket costs (TrOOP)  costs [including the portion of the coverage gap discount for brand-name drugs paid by the drug manufacturers; discounts paid by the insurance carrier for generic (35%) and brand-name drugs (2.5%) are NOT included in TrOOP  BUT the 50% manufacturers' discounts are)] total $4,550  Some available Part D plans offer coverage in the coverage gap for certain medications.  Plan D drugs now cover barbiturates, and benzodiazepines used in the treatment of epilepsy, cancer and chronic mental disorders.  NOTE:  One set of calculations (total drug cost) determine how you ENTER the coverage gap; another set of calculations (TrOOP) BEFORE and DURING the coverage gap determine how you GET OUT of the gap and enter catastrophic coverage.

To clarify, in 2015 the coverage gap begins at $2,960 ($3,310 in 2016) and the catastrophic level begins at $4,700 ($4,850 in 2016).  During the coverage gap beneficiaries will pay 65% (58% in 2016) for generic drugs and 45% for brand-name drugs, and 65% (58% in 2016) and 45% respectively will count as TrOOP. Once TrOOP reaches $4700 ($4,850 in 2016) beneficiaries will pay the greater of 5% or $2.65 ($2.95 in 2016) for generic drugs and 5% or $6.60 ($7.40 in 2016) for brand-name drugs.

Plans are required to include medication therapy management including step therapy, quantity limits and prior authorization.

Click here to find charts showing how the donut hole will be phased down to 25% (differently for non-generic drugs than for generic drugs) between 2011 and 2020 (participants will pay 65% for generic drugs and 45% for non-generic drugs in 2015).

You may owe a late enrollment penalty (LEP) 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. The late enrollment penalty is assessed for EACH month  that you haven't had creditable drug coverage and changes annually because it is based on the national average Part D premium which changes annually

Part D Prescription Drug Plan premiums are adjusted if your income exceeds a certain level. This additional premium (called the IRMAA) will be deducted from your Social Security check.  Click here for additional details.  Adjustments for 2015 are made from income reported for 2013.

Besides Medicaid, there are four other ways to save on Medicare Part D prescription drug costs.

Click here  for information about the extra help (low income subsidy) program and here to apply online for extra help.

Note:  For a complete listing of plans available in your service area please contact 1-800-Medicare or consult with (TTY uses should call 1-877-486-2048).  Hours of operation are 24 hours a day, 7 days a week.  Your copy of Medicare & You 2015 also contains a listing.



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