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2010 Part D Benefits Overview

What are The Medicare Part D Benefits?

Medicare Part D helps to cover the costs of prescription drugs. Medicare-approved private insurance companies, , offer Part D Plans. People who have Medicare Part A or Medicare Part B are eligible for Medicare prescription drug coverage. You can enroll in any of the Part D plans that serve the area where you live. Our easy to use Part D Comparison Tool can help you compare and choose a plan.

The 2010 Annual Election Period for Part D plans is from November 15 to December 31. During that time period, anyone with Medicare can enroll in a plan or change from one plan to another. You can enroll anytime if you qualify for extra help. Likewise you can sometimes join, switch or drop Medicare drug plans at other time some of these include: if you move from a plan’s service area, if you live in a nursing home or other assisted care institution. In these cases you need to join or switch as soon as possible.

What should I consider when choosing a plan?
 

• Costs - The Medicare Plan Comparison Tool helps you compare costs such as premiums, co-payment/co-insurance and deductible expenses. We can also help you compare annual costs, based on the drugs you take.
   
• Doctors/Providers - If you are part of a Medicare Advantage Plan like an HMO or PPO, and get your Part D coverage as part of this plan, you need to make sure that you’re able to visit the providers you want. If the provider you prefer is out of network or referrals are needed, you will need to check if there will be any additional costs if you continue to see them.
   
• Travel - Are my drugs covered if I travel (or live part-time) in another state? If you are part of a Medicare Advantage Plan, and get your Part D coverage as part of this plan, you should make sure that your plan provides coverage in that state.
  

What are my coverage costs?

• Premium - You pay a monthly premium for Part D, which varies from plan to plan.
   
• Deductible – Your annual deductible depends on your plan. Most plans have a deductible, and you usually pay all of your drug costs up to that amount. After you have paid the deductible for your drugs, you usually pay 25% of your prescription drug costs up to the coverage limit.
   
• Initial Coverage Limit – The coverage limit is $2,830, but drug plans may have a lower limit. Once this limit is reached for prescription drugs, your coverage stops. You are responsible for paying 100% of the drug costs up to $4,550 (including the costs of the deductible and coinsurance). This period is known as the Coverage Gap or Doughnut Hole.
   
• If you reach the coverage gap in 2011, you will get a 50% discount on covered brand-name prescription drugs at the time you buy them. There will be additional savings for you in the coverage gap each year through 2020 when you will have full coverage in the gap. Talk to your doctor or other health care provider to make sure that you’re taking the lowest cost drug available that works for you.
   

• Catastrophic Coverage – Once you have reached the out-of-pocket costs of $4,550, you qualify for catastrophic coverage. Some drug plans may have a lower out-of-pocket limit. You will pay no more than 5% of your drug costs for the remainder of the year. Only 4% of beneficiaries reach the Catastrophic Coverage period. The following conditions or drug classes most frequently reach the Coverage Gap during the year:
  

  • Alzheimer’s
     
  • Oral Anti-Diabetics
     
  • Proton Pump Inhibitors
     
  • Anti-depressants
     
  • Angiotensin Receptor Blockers
     
  • Statins
     
  • Osteoporosis
     
  • ACE Inhibitors
     

What can I do to prevent hitting the Coverage Gap or Doughnut Hole? 

• Find Medicare Part D plans that cover all of your medications.
   
• Find out whether there are generic alternatives for any of your medications.
   
• Find out if any of the local pharmacies offer your drugs at low cost.
   
• Buy your medications from a mail-order pharmacy through your Part D plan. Mail-order pharmacies through your Part D plan typically provide a 3-month supply of your prescriptions for the cost of two copayments.
  
  

Is there any extra help for my Medicare Drug Plan costs? 

You have to join a Medicare drug plan to get Extra Help paying your drug costs. If you qualify, there is financial assistance available for monthly premiums, yearly deductibles, and prescription copayments. The amount of help you receive will depend on your income and resources.

You automatically qualify for Extra Help if you have any one of the following:

• You have complete Medicaid coverage.
   
• You get help from a state Medicaid program paying Part B premiums as part of a Medicare Savings Program.
   
• You get Supplemental Security Income (SSI) benefits.
   

If you don’t automatically qualify for Extra Help, you may still apply.

• If you qualify, you still need to join a Medicare drug plan to get Extra Help.
   
• If you qualify, and you don’t join a drug plan, then Medicare will enroll you in a Medicare drug plan.
   
• If you think you may qualify for Extra Help, you may call Social Security at 1-800-772-1213, visit the Social Security website (www.socialsecurity.gov), or apply at your State Medical Assistance (Medicaid) office.
   

What drugs are not covered? 

There are drugs that the Centers for Medicare & Medicaid Services (CMS) does not require the plans to cover. These drugs are also known as excluded drugs. Some plans may include these drugs as an added benefit.

The Centers for Medicare & Medicaid Services (CMS) does not require these categories of drugs to be covered:

• Barbiturates (seizure drugs)
   
• Benzodiazepines (anxiety drugs)
   
• Weight loss or weight gain
   
• Fertility
   
• Cosmetic (e.g., hair growth)
   
• Cough and cold
   
• Nonprescription drugs
   
• Smoking Cessation (prescription smoking cessation drugs are covered)
   
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
   

Our Medicare Part D plan comparison tool will help you find out if these drugs are covered by the Part D plans.

If you are ready to enroll, start here by clicking below:

• Enroll In A Part D Plan Or;
   
• Learn More About Part D Coverage