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If you do not receive Prescription Drug Coverage through Part C (Medicare Advantage Plan), you will need to purchase a standalone Prescription Drug Plan (PDP) to cover your medications and prevent paying a penalty for not having Part D. Coverage on these PDP’s vary greatly and are determined by the specific medications you’re currently taking, the county you live in and your monthly budget. It’s important to remember that your medications will not be covered the same on each plan, and coverage may vary based on details such as: type of medication, generic vs brand, and dosage. You should also be mindful of the Donut Hole – also known as the “Coverage Gap” phase – prior to selecting your prescription drug coverage. This is when you will pay a larger percentage out-of-pocket for your medications for the remainder of the year once you have reached the Initial Coverage Limit of $3750.00. You exit the Donut Hole or “Coverage Gap” phase once you reach the Catastrophic Limit.

At HRBC we want to make sure you know everything about Prescription Drug Coverage, Medicare Part D.  Medicare Part D is the most recent addition to the Medicare program; and anyone with Medicare Parts A and B is also eligible for Medicare Part D. To get Medicare Part D drug coverage, you must join a plan through a private health insurer approved by Medicare. Each plan can vary in cost and the drugs covered; as each specific health insurance company has their own drug formulary.

There are two different ways to get Medicare prescription drug coverage:

  • Medicare Part D Prescription Drug Plans. These plans (sometimes call “PDPs”) add drug coverage to original Medicare coverage, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  • Medicare Advantage Plans (MAPD) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage.  Through an MAP, you get all of your Part A, Part B coverage and prescription drug coverage, Part D, through these plans.

MEDICARE PART D ELIGIBILITY

Eligibility for Medicare Part D is also for those who do not already have “creditable” prescription drug coverage. Creditable prescription drug coverage (for example, from an employer or union) is coverage that is expected to pay at least as much as Medicare’s standard prescription drug coverage.

People who have this kind of “creditable” coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty, if they decide to enroll in Medicare prescription drug coverage later.

However, if you do not have “creditable” prescription drug coverage and you do not enroll in a Part D plan or a Medicare Advantage plan with prescription drug coverage when you are first eligible, you may be required to pay a “late enrollment” penalty if you later enroll in a Part D plan.

Here are a few examples of creditable coverage:

  • Covered by pension program. Some seniors receive prescription drug coverage as part of their pension package. They would normally not be eligible for Medicare Part D.
  • Covered by employer. If a Medicare enrollee is currently employed and his or her employer provides prescription drug coverage, they would normally not be eligible for Medicare Part D.
  • Covered by union. Many unions offer prescription drug coverage for their retired members. They would normally not be eligible for Medicare Part D.
  • Covered by a Medicare Advantage Plan. Many Medicare Part C (Medicare Advantage) programs already include prescription drug benefits. They would normally not be eligible for Medicare Part D.

FAQ’S ABOUT THE DONUT HOLE

While researching Medicare Prescription Drug Plans with your HRBC representative, you may have questions about the “donut hole.”  The “donut hole” is simply a gap in coverage that occurs once you and your plan have met a pre-set spending limit for medications. When that limit is reached, the prescription drug plan stops paying, and you are responsible for 100% of your medication costs, for a time. If you reach the next spending plateau, the prescription plan kicks back in and pays an even higher portion of your drug costs.  Keep in mind that every prescription drug plan currently comes with a donut hole and the good news is that many people never reach the donut hole!  This coverage gap should be phased out by 2020.

Review Your Medicare Part D Options now. For more information about your Medicare Advantage Plan and Medicare Supplement options, or to speak with one of our Medicare trained agents, fill out the contact form to the right.