|
|
 Home  Xml
Feed  Submit Articles  Editor Login  Contact us |
 |
 |
|
|
Introduction One of the benefits of Medicare is the ability to participate in Medicare prescription drug plans, also known as Medicare Part D. Participants in these plans receive assistance in paying for prescription drugs. Before the adoption of Medicare Part D, many patients often wound up paying the full cost out-of-pocket for prescription medication. Eligibility People who receive Original Medicare coverage and participate in Part A or Part B are eligible for Medicare prescription coverage (Part D). People who are in the Medicare Advantage program receive prescription drug coverage as part of their insurance plan. People who receive prescription drug coverage through the Medicaid program are usually transitioned to Medicare Drug coverage when they become eligible for Medicare. How It Works Medicare participants must choose to participate in Part D; coverage is not automatic. People select coverage from an approved list of providers. Each plan is different. Coverage, costs, and premiums vary significantly, so each person must select the plan that is best for them. The law mandates a standard benefit which is the minimum coverage that each plan must provide, but many plans offer more coverage than the standard benefit. The cost of a particular drug varies among the plans because each insurance company negotiates its own pricing agreements with drug providers. Medicare Advantage plans vary in the drug coverage that they provide as well, so prescription drug coverage is an important consideration in choosing a Medicare Advantage plan. Some Medicare Advantage plans charge an extra premium for dug coverage while others do not. How Much Does It Cost? Under the standard benefit, participants in Part D plans must pay a monthly premium that varies by plan. Participants also pay an annual deductible, which is currently $310. Participants share in the cost of each prescription either through a co-pay or a percentage of the prescription cost. When total drug costs paid by both the participant and the insurance company reach a given amount for the calendar year, the plan changes. Currently, that total cost amount is $2840. This amount can change over time. When costs exceed the initial coverage limit, the participant pays for a greater portion of the prescription. This change in coverage is known as the “doughnut hole.” In the “doughnut hole,” participants must pay 50 percent of the cost of brand-name drugs and 93 percent of the cost of generics. When total costs again exceed a certain level, which is currently $4550, participants enter the catastrophic period of coverage. During the catastrophic period, participants are required to pay no more than 5 percent of the cost of prescriptions. Legislation has been enacted that will eliminate the “doughnut hole” by 2020. Participants who exceed certain income levels are also required to pay a monthly surcharge to Medicare that varies according to income. Choosing a Plan Medicare participants should keep in mind that the drugs that they use are the most important consideration in choosing a plan, not co-pays and premiums. Each plan charges different prices for each drug and each plan provides coverage for different drugs. Participants should seek plans that cover the drugs that they need for the lowest cost. Participants can change plans annually, but must keep the same plan for the entire calendar year.
About the Author:
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Medicare Prescription Drug Plans
