Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug coverage, Part D, for everyone with Medicare. This coverage may help lower prescription drug costs and help protect against higher costs in the future. Part D is optional however if you decided not to enroll in a Medicare drug plan when you are first eligible, you may pay a penalty (a higher premium) if you choose to join later. Individuals can enroll or change plans typically only during the open enrollment period which is conducted from November 15 – December 31 each year. However Special Enrollment Periods 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 includes prescription drug coverage as part of the plan. Such plans include Tufts Medicare Preferred HMO/PPO, Medicare HMO/PPO Blue, Fallon Senior Plan and First Seniority Freedom. Individuals can also choose to receive Medicare prescription benefits through a stand alone plan. These plans only offer prescription benefits without additional benefits. In 2008 there are 51 stand alone prescription drug plans in Massachusetts. Each of these plans differs in premium costs and drug coverage.
The standard prescription drug benefit in 2008 has a deductible of $275 and then an individual will pay a copayment for their medications until they have totaled $2,510 (including what you pay and what the plan pays). At that point an individual is responsible for paying the full price of their medications until they have spent a total of $4,050 out of their own pocket. This is considered the coverage gap or “donut hole” . After that point an individual is only responsible 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.
MassMedLine can assist patients by reviewing their list of medications and providing suggestions on which of the many plan options would work best for them. In addition MassMedLine can explain how their Medicare Part D plan works specifically for them and how it works 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, or when they have reached the coverage gap or “donut hole”.