Medicare Part D provides some coverage for the cost of prescription medication on behalf of eligible dependents enrolled into the program. A familiarity of the basic concept will help make an educated and intelligent decision before purchasing the benefit which is after all offered through private insurance carriers. This article was created for those considering coverage and is intended to provide a conceptually easy way of understanding exactly what it can do for you.
Who is eligible.
If you are entitled to Medicare Part A or are enrolled in Medicare Part B, you may join a Medicare Part D prescription drug plan. Participation is voluntary for most people. However, if you receive benefits through Medicaid you are automatically enrolled in a Part D plan in order to continue receiving prescription coverage.
Who Administers The Program?
Medicare operates the overall program, but you must choose one of the specific Part D drug plans offered by private insurance companies in your state. It is ultimately your decision to enroll directly with the carrier.
What Is The Cost For Participation?
Most people pay a monthly premium to the insurer. Premium dollar amounts may range $0.00 through $50.00 per month depending on the plans available within your geographic area and also on the particular level of benefits chosen.
What Is The Coverage?
All plans cover some, but not all, prescription drugs in every category of medication. Each plan has its formulary list in which consist of the specific prescriptions covered. The plan will pay its share only for drugs listed and purchased from a pharmacy or other distributor that participates in that plan.
How Much Is The Reimbursement or The Amount The Plan Pays?
For Basic Part D coverage there are four payment allocations which comprise of deductibles, partial coverage, coverage gaps, and catastrophic coverage.
Deductible: You pay for the first $295.00 per year of the total cost of your drugs. A few high premium plans waive this deductible.
Partial Coverage: Once your total yearly drug expenses reaches $295.00 and before it reaches $2,700.00, the plan pays 75% or you pay 25% of your drug cost. Your portion comes in the form of a copayment for each prescription. Your copayment may be higher for brand name drugs, or less for generics, depending on your plan.
Coverage Gap: more commonly referred to as "The Doughnut Hole". Once your total yearly drug expenses reaches the threshold of it's maximum allowable which is $2,700.00, you must pay the entire amount of your drug cost. Your plan generally pays no part of your prescription drug cost within this doughnut hole, although a few high premium plans may pay some portion of your cost.
Choosing The Right Plan.
Not all plans are alike, and choosing the best plan for you involves several steps. You must get the most comprehensive possible coverage of the drugs you take, with fewest restrictions on availability. You must also accomplish this means with the lowest overall out of pocket cost to you. This does not necessarily mean the lowest premiums or deductibles. Choosing the right plan can be a difficult and cumbersome endeavor, if you need assistance in this regard, please visit our website at http://www.health-insurance-buyer.com and leave your contact information so one of our licensed insurance agents can help you with a no hassle quote and free consultation.
Carlos Diez is a senior benefits consultant for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. He holds life, health, and annuity licenses in 48 states and is appointed with over 88 carriers. For contact information please reach him at http://www.health-insurance-buyer.com/
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