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Call Now: 1-856-866-8900 (Moorestown Office) OR 1-908-272-1970 (Cranford Office) |
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Senior Advisors believes this to be the most important decision one makes regarding their Medicare Coverage. There are 20-30 Part D drug plans available in every state. Not making the right decision on a drug plan could result in a mistake that could cost thousands of dollars in extra expenses.
Part D: Initial Coverage Level
Under Part D, the Federal Government covers $3,750 (in 2018) in drugs based on the full retail cost of the drugs. There are co-pays (or coinsurance) that will be paid for each prescription while in the Initial Coverage level.
Part D: Coverage Gap (aka "Donut Hole")
After exceeding the $3,750 of prescriptions, you will begin the gap or "donut hole" coverage. In the "donut hole" you pay a significant portion of your prescription drug costs.
These percentages will continue to get smaller and smaller until 2020 when the maximum that you will pay in the donut hole will be 25% of the cost for all prescriptions until you meet the catastrophic tier - $5,000 in True out-of-pocket costs (in 2018).
Part D: Catastrophic Coverage
If you reach the Catastrophic tier, you will only have to pay 5% of the cost or $3.35 for generics or $8.35 for name brand drugs whichever is greater.
Part D Analysis
Analyzing each person's prescription needs is so important because some drugs may not be covered by some of the drug card companies. Also the drug card companies have multiple plans and the list of covered medications may be different for each plan. If a drug is not covered, the policy holder will have to pay the full cost of the drug. There will never be a discounted cost in the "donut hole" and never a reduced price in the catastrophic level. One can analyze this by going to the Federal Government's website at www.medicare.gov. Another option is to let the Senior Advisors help you with this process.
It is important to analyze your needs every year. Each individuals prescriptions can change throughout the year and the plans can change each year. The only time you can change a drug card is during the Open Enrollment Period. The Open Enrollment Period is October 15 through December 7 for a January 1 effective date.
Part D: Initial Coverage Level
Under Part D, the Federal Government covers $3,750 (in 2018) in drugs based on the full retail cost of the drugs. There are co-pays (or coinsurance) that will be paid for each prescription while in the Initial Coverage level.
Part D: Coverage Gap (aka "Donut Hole")
After exceeding the $3,750 of prescriptions, you will begin the gap or "donut hole" coverage. In the "donut hole" you pay a significant portion of your prescription drug costs.
- Brand Name - you pay 35% the cost of the drugs in the donut hole
- Generics - you pay 44% the cost of the drugs in the donut hole of the cost.
These percentages will continue to get smaller and smaller until 2020 when the maximum that you will pay in the donut hole will be 25% of the cost for all prescriptions until you meet the catastrophic tier - $5,000 in True out-of-pocket costs (in 2018).
Part D: Catastrophic Coverage
If you reach the Catastrophic tier, you will only have to pay 5% of the cost or $3.35 for generics or $8.35 for name brand drugs whichever is greater.
Part D Analysis
Analyzing each person's prescription needs is so important because some drugs may not be covered by some of the drug card companies. Also the drug card companies have multiple plans and the list of covered medications may be different for each plan. If a drug is not covered, the policy holder will have to pay the full cost of the drug. There will never be a discounted cost in the "donut hole" and never a reduced price in the catastrophic level. One can analyze this by going to the Federal Government's website at www.medicare.gov. Another option is to let the Senior Advisors help you with this process.
It is important to analyze your needs every year. Each individuals prescriptions can change throughout the year and the plans can change each year. The only time you can change a drug card is during the Open Enrollment Period. The Open Enrollment Period is October 15 through December 7 for a January 1 effective date.
Video Overview: Part D of Medicare
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If you are a visual learner (like me), here is a video overview for Part D for 2015 & 2016.
(The structure is the same for 2018, just some of the numbers changed as noted above.) |
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FREE Annual Review of Part D Prescription Drug Coverage Plan
For all of our Medicare customers, Senior Advisors offers a free annual review of your prescription coverage and will always be there to assist you with your Part D plan.
Call Now: 1-856-866-8900 (Moorestown Office) OR 1-908-272-1970 (Cranford Office)
