Helping People 65+ in New York and Long Island Understand Medicare Prescription Drug Plans
Medicare Part D: Helping Medicare Recipients Get Affordable Prescriptions
When you go to the doctor, you might present your Medicare card as proof that you have health insurance. However, if your doctor writes you a prescription, you can’t take your Original Medicare with you to the pharmacy and expect to get coverage. You’ll need Medicare Part D prescription insurance if you want coverage for your drug costs.
Medicare Part D prescription drug plans bridge the gap between Original Medicare and private benefits. If you get a plan, you’ll make your medications more affordable. Come to Senior Healthcare Solutions, and we’ll help you get the Medicare Part D plan that is of the most benefit to you.
Medicare offers prescription drug coverage through private companies to everyone with Medicare. Even if you do not take prescription drugs you should still strongly consider joining a plan. If you decide not to join a plan and do not have credible prescription drug coverage you will likely pay a late enrollment penalty.
What is Medicare Part D Prescription Coverage?
Original Medicare is the government’s tax-supported health insurance program for senior citizens and other qualifying individuals. The standard Original plan contains two types of coverage.
- Medicare Part A will cover hospital costs, like inpatient stays, surgeries and related treatments.
However, where you won’t have coverage on Original coverage is at your pharmacy. Still, millions of people rely on prescription medication to maintain their health. To get coverage for these costs, you will have to get Medicare Part D prescription coverage. With coverage, rather than paying for what might amount to hundreds of dollars in medication costs, you’ll generally only pay a small cost out of pocket.
There are two ways to get Medicare prescription drug coverage:
1) Medicare Prescription Drug Plans - These plans sometimes called PDP's add drug coverage to Original Medicare.
2) Medicare Advantage Plans - These plans such as HMOs and PPOs usually have a prescription plan included in them for no additional cost
If you have employer or union coverage, call your benefits administrator before you make any changes or sign up for coverage. If you drop union or employer coverage you may not be able to get back in. Also if the employee drops their coverage his spouse or family might loose theirs. So proceed cautiously.
How Does Your Coverage Work?
Medicare Part D plans are private plans offered by major insurance companies. They have their own premiums and cost structures. So, when you go to get a prescription filled, you’ll have to verify the exact personal cost. You might have to pay the:
- Part D Premium: This is the cost you pay for your plan in general.
With all Medicare drug plans you might enter a temporary coverage gap called the Medicare Donut Hole. When you enter this hole, you’ll pay more for your drugs for a time. You’ll enter the hole after you and your plan have paid a combined $3,820 (2019) for drugs that plan year. You’ll remain in the hole until you pay a total of $5,100 (2019). You’ll then exit the hole and your plan will then resume paying for most of your costs.
There are 20 different PDP plans offered in New York. Each has a preferred pharmacy network and each has a different formulary of drugs. This task should be undertaken by a Medicare professional to insure the best fit. Premiums range from $16 - $91 per month.
What Will My Plan Look Like?
All Part D plans will vary in how they cover different medications. Most contain elements like:
The Formulary: This is a list of Medications that the plan will cover. Covered drugs might vary by plan.
Tiers: Different plans separate drugs into categories called tiers. The costs you pay will vary based on the tier of coverage. Usually, generic drugs will fall into the lowest tiers and cost the least. Drugs in the highest tiers are usually specialty or brand-name drugs that usually cost the most.
Drugs not within your plan’s formulary will not have coverage under your policy. Therefore, talk to your doctor about whether your plan will provide help. Our agents can also help you determine the right course of action.
Who qualifies for Medicare Part D?
If you qualify for Original Medicare, you’ll qualify for a Part D plan. Eligible parties include:
Keep in mind, you’ll have to get a plan that is offered in your area. To have the full benefit of your coverage, you’ll need a localized plan.
Most people enroll in Part D coverage:
- During their initial enrollment period (IEP) for Part A & B coverage. For senior citizens, this is the 7-month period around your 65th birthday when you first become eligible for Original Medicare.
Critical Factors to Consider When Choosing a Plan:
Plan Formulary (Are my drugs covered?)
Preferred or non preferred drugs
Preferred or standard pharmacies
Premiums/ copays/ deductibles
Who do You Call with Medicare Questions?
To get help with all your Medicare Part D Prescription insurance questions and needs, call Senior Healthcare Solutions today at 631 539-6351. We can help you get covered today!
You can also contact the Medicare system directly at:
- National Phone Number: 1-800-MEDICARE (1-800-633-4227)
- TTY Phone: 1-877-486-2048
- Medicare Contact Center Operations
PO Box 1270 Lawrence, KS 66044
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