MEDICARE PART "D"
What is Medicare Part D prescription drug plan?
It is a prescription drug plan for people on Medicare. It can be added to original Medicare. Part D are also included in some Medicare advantage plans such as an HMO, PPO of PFFS.
It helps you pay for both brand-name and generic prescription. Medicare drug plans are offered by Insurance companies approve by Medicare.
Is there a Premium?
Depending on the plan you may have both a monthly premium and a share of cost of your prescription. The plan may include a deductible as well as a coinsurance.
What does it cover?
Each Medicare drug plan has its own list of covered drugs (called a formulary). All plans must cover a wide range of prescriptions drugs that people with Medicare take, including most drugs in protected classes “like drug to treat cancer or HIV. Most Plans place drugs into different level called tiers. Drugs in each tier have different copays. A lower tier will generally cost less than a drug in a higher tier.
Will my plan have limitation?
Most Medicare prescription drug plan have specific rules such as prior authorization may be required for a medication. There may also be quantity limits on your medication. You may also require step therapy to receive a certain medication.
What is the coverage gap (also called the donut hole)?
Most Medicare drug plans have a coverage gap. This means there's a temporary limit on what the drug plan will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs.
Once you and your plan have spent $4,130 on covered drugs in 2021, you're in the coverage gap. This amount may change each year.
Also, people with Medicare who get Extra help paying Part D won’t enter the coverage gap.
Cost when you reach the coverage gap
Once you reach the coverage gap, you'll pay no more than 25% of the cost for your plan's covered brand-name prescription drugs.
You'll pay this discounted rate if you buy your prescriptions at a pharmacy or order them through the mail. Some plans may offer you even lower costs in the coverage gap. The discount will come off of the price that your plan has set with the pharmacy for that specific drug.
Although you'll pay no more than 25% of the price for the brand-name drug, almost the full price of the drug will count as out-of-pocket costs to help you get out of the coverage gap.
What you pay and what the manufacturer pays (95% of the cost of the drug) will count toward your out-out-pocket spending.
This information obtained from Medicare.
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