WHAT YOU NEED TO KNOW
Important facts about Medicare Part D
Knowing the common
terms will help make sense of
Medicare Part D.
- You pay a monthly premium for your coverage.
- A deductible is the annual amount you pay out-of-pocket before your insurance starts. There are
plans available that do not have an annual deductible.
- Each time you fill a prescription, you may have to pay a copay or coinsurance.
In Medicare prescription drug plans, you pay a set amount, and the plan pays the remaining cost.
about the coverage gap will help you avoid it.
2011, the coverage gap begins after you and the plan together have spent $2,840 in total yearly drug costs. At
this point, you will pay approximately 50% of your discounted prescription drug costs for brand named drugs and 93% of the
discounted prescription drug costs for generic drugs until you reach $4,550 in yearly true out-of-pocket drugs costs.
There are plans available that have coverage during the gap but most of these plans only cover generic drugs. True out-of-pocket
costs are your share of the prescription drug costs in a Medicare Part D plan; such as deductibles, copays (if applicable),
and the amounts you pay in the coverage gap. It does not include monthly premiums. Once you reach catastrophic coverage,
your plan will pay most of your drug costs until the end of the year.
You can cut costs
by using generic prescription drugs.
drug is approved by the U.S. Food and Drug Administration (FDA) and is therapeutically equivalent to its brand-name
drug equivalent. To win FDA approval, the generic drug must contain the same amounts of the same active ingredients
as its brand-name equivalent. For both brand-name and generic drugs, the FDA applies the same standards for identity, strength,
quality, purity and potency. Generic drugs usually cost less and are sold under a generic name for the brand-name drug (usually
its chemical name). Because generic drugs are less expensive than their brand-name equivalents, your copay is usually less.
You should consult with your doctor to determine whether you can lower your prescription drug costs by using generic drugs
instead of more expensive brand-name drugs.
At home or away, there are convenient locations
to fill your prescriptions.
To keep your
costs as low as possible, your prescriptions must be filled at network pharmacy as listed by the insurer. Most
insurance companie's network includes most of the national retail pharmacies.
plans allow you to maximize your prescription savings with home delivery.
Some plans allow you to enjoy additional savings and convenient home delivery for the medications you take on a regular
basis when you order through their preferred mail service pharmacy.
You can enroll during open enrollment
The annual enrollment period runs
from November 15 through December 31(2010). If you are a current plan member, you are automatically enrolled
for the next calendar year unless you change plans or contact your insurer and cancel your plan. You may still
enroll in a plans outside of the annual enrollment period if you:
- Qualify for a low-income subsidy
- Are eligible for both Medicare and Medicaid and want to switch plans
- Qualify for a Special Election Period
- Are turning 65
- Are otherwise
newly eligible for Medicare
You can avoid paying the late enrollment penalty.
If you choose not to enroll in a Part D plan when eligible, you could incur Medicare's
late enrollment penalty that is equal to about 1% of the national average premium per month. There is no limit to the
percentage, and it lasts as long as you are enrolled in a Medicare Prescription Drug Plan. The fee won't apply if
you move from an insurance plan that offers creditable coverage to a Medicare Prescription Drug Plan.
you qualify for a low-income subsidy you can receive financial help.
If you are living on a low or fixed income, you may qualify for help with your plan costs. If you qualify, you could
get help paying for some or all of your plan's monthly premiums, annual deductible (if
there is one), as well as some or all of the cost of your drug copayments. In all, if you qualify, you could
receive financial help paying for your prescription drug plan expenses. In addition, if you qualify for a low-income
subsidy (LIS), you can join a plan without having to pay a late-enrollment penalty.
To find out more, and to apply for extra help, call 1-800-MEDICARE
(1-800-633-4227); TTY/TDD machine users should call 1-877-486-2048, 24 hours a day/7days a week), or Your State Medicaid Office,
or the Social Security Administration at 1-800-772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday; TTY/TDD machine
users should call 1-800-325-0778. There is no penalty or fee for applying for extra help if you're not sure if you qualify.
Please keep in mind, it could take up to 8 weeks for your low-income subsidy application to be processed and approved, so
apply early. Remember, applying for extra help with the Social Security Administration does not automatically enroll
you in a Medicare Part D prescription drug plan. You must enroll separately with a plan provider to get prescription drug
coverage. Even if you're denied extra help, you can still enroll in a prescription drug plan.
are three ways to pay for coverage.
- Convenient and automatic deduction from your checking or savings account. Check with your
plan insurer for help in signing up for automatic debit from your checking or savings account.
Check by mail.You
may write a check each month and send it in using your coupon book which you will receive after you have enrolled.
- Automatic Deduction from your Social Security
benefit check. The SSA deduction may take two or more months to begin. In most cases, the first deduction from your
SSA benefit check will include all premiums due from your enrollment effective date up to the point withholding begins.
If you qualify for extra help with your Medicare prescription
drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a portion of this premium,
your plan will bill you for the amount that Medicare does not cover.