Medicare Part D Prescription Drug Coverage
Medicare offers prescription drug coverage, also referred to as Part D, for all Medicare beneficiaries. This coverage may help lower prescription drug costs and help protect against higher costs in the future. Part D is optional however, if a beneficiary chooses not to enroll in a Medicare drug plan when first eligible, they may pay a penalty (a higher premium) if they decide to join at a later date. Individuals can enroll or change plans only during the open enrollment period from November 15 – December 31 annually. Special Enrollment Periods (SEP’s) are provided to individuals who meet certain criteria. For more information about Special Enrollment Periods please contact our office.
There are two ways to get Medicare prescription drug coverage. One option is to enroll into a Medicare Advantage plan that offers supplemental health insurance and prescription drug coverage as part of the plan. Individuals can also choose to receive Medicare prescription benefits through a stand alone drug plan. These plans only offer prescription coverage without additional benefits. The standard prescription drug benefit in 2010 has a deductible of $310 and beneficiaries pay copayments for their medications until they have reached a total of $2,830 (this total includes what the patient pays added to what the plan pays). At that point, Medicare beneficiaries are responsible for paying the full price of their medications until they have spent a total of $4,550 out of their own pocket. This period is called the coverage gap or “donut hole”. Once the gap amount is met, an individual is then responsible only for a 5% copayment. Some plans offer coverage beyond this standard benefit by reducing the deductible or providing coverage for generic medications in the coverage gap.
MCPHS Pharmacy Outreach Program can assist patients by reviewing their list of medications and providing suggestions on which of the numerous plan options would work best for them. In addition, MCPHS Pharmacy Outreach Program can explain how their Medicare Part D plan works specifically in conjunction with MassHealth, Prescription Advantage, and Medicare’s Extra Help. We can also assist patients who are having difficulties with their plans such as billing issues, medications not being covered, prior authorizations, or when they have reached the coverage gap or “donut hole”.