Medicare Part D will soon face some significant changes in 2020. Whether you are currently a Medicare enrollee or are applying for prescription drug coverage for the first time, it is essential to learn as much as you can about the various plans that are available to you.
Medicare Part D is a program organized by the federal government in 2006. Those enrolled in a Part D plan receive discounts for their prescription drugs by either joining a Prescription Drug Plan or a Medicare Advantage Plan. Open enrollment for Medicare Part D 2020 coverage begins on October 15, 2018, and ends on December 7, 2018.
There are two plans that eligible Medicare recipients can apply for when enrolling in Medicare Part D. They are the Prescription Drug Plan or PDP that only covers the cost of prescription drugs, and the Medicare Advantage Plan or MA that covers both prescription medication and various types of medical services such as in-home care or occupational therapy.
Medicare Part D uses a tiered formulary system to determine how much they will pay for various types of prescription drugs. Therefore, some lower-cost brand-name or generic drugs will be very affordable to Medicare recipients while more expensive drugs will have a much higher co-pay. Because of this, some enrollees will choose some of their prescribed medications over others each month.
Seniors who already have health insurance throughout a private insurance plan may want to consider all their options before they make the switch to Medicare Part D. There are some advantages of private health insurance that you do not get with Medicare prescription drug coverage. It is possible that you could lose some prescription drug coverage that you need, and you may not be able to get it back at a later time.
Those who are eligible for Medicare can change their Part D plan during open enrollment which takes place between October 15th and December 7th in 2018. Many people choose to switch during this time because the cost of their covered medication, their monthly premium costs, or their deductible amount can change annually. During open enrollment, recipients have the chance to compare all their options and choose the one that is the most affordable, or the one that will benefit their specific healthcare needs the most.
Those who are satisfied with their existing Part D coverage should still get in contact with their plan provider to find out if there will be any changes made to their overall coverage cost and the medications that their plan cover for the upcoming year.
The cost of Medicare Part D depends on many different factors for each. These factors can include everything from the state you live in, to the plan that you choose. Currently, the average monthly premium for Medicare Part D plans is $34 in 2018.
The best way to ensure that you pay the lowest possible rate is to find a plan with the lowest premium that suits your needs. This plan will also have the lowest annual cost.
Keep in mind that Medicare Part D plans with a high deductible may have a lower monthly premium, but you will pay more out of pocket costs until your deductible is paid off for the year.
At the same time, plans that have no deductible will start to cover the costs of your prescription drugs instantly, but these plans will also have a higher monthly premium.
Most Medicare Part D enrollees will have a co-pay on all their prescription drugs. The amount that you pay will depend on the plan you choose and the type of medication you are buying. Your co-pay is a fixed amount that you pay out of pocket for your prescriptions. You may have to spend under $5 for some medication while others may cost between $20 and $40 or more.
Coinsurance is the percentage of the cost of your prescription drugs. Most Part D plans will require co-insurance for all drugs listed in higher tiers such as tier 4 or 5. For example, if the original price for your prescription is $410, and your coinsurance is 25 percent, you will only have to pay $102.50.
Sometimes your prescription drugs will require a co-insurance, other times they may need a fixed co-pay. It’s important to check out the cost of each of your current medications for each Medicare Part D plan before you make a final decision.
Co-Pay Tiers are different levels of prescription drugs that Medicare Part D pays. Each tier will have the co-insurance or fixed co-pay amount listed. While a Part D plan may cover all your medication, you may be paying different amounts for each one depending on their tier.
Each Medicare Part D plan encourages their participants to use the lowest-cost drug for their health conditions. Unfortunately, this often means switching from a brand-name prescription to a generic.
The tiers most frequently used are the top 4. However, there are drugs listed in Tier 5 and so on. Tier 1 covers generic medicines which are the least expensive. It also includes a few affordable brand-name options. Tier 2 is the preferred level. It covers brand-name drugs that are considered the most effective for the conditions they treat. Tier 3 lists prescription medication that is non-preferred or brand name that is not found to be the most effective in their group. This tier may also include some preferred specialty medication. And Tier 4 features specialty drugs which are the most expensive brand-name prescription products.
There is a point during each year where Part D benefits stop paying for your prescription medication known as the Medicare Coverage Gap or more commonly as the donut hole. In 2018 recipients would reach the coverage gap when their total prescription drug costs went beyond $3,750 annually.
In 2011, the rules for the coverage gap started to change, and now Medicare beneficiaries can receive more help paying for their prescriptions after they reach the coverage gap. We can expect even more improvements on this matter in 2020.
Catastrophic coverage is another type of discount that Medicare Part D enrollees receive. This coverage starts when your out of pocket costs exceed $5,000. That would be around $7,509 in total drug costs that Medicare helped to pay in a single year. If you reach that amount for your prescription drugs, all Medicare Part D plans will cover as much as 95 percent of your prescription medication costs for the remainder of the year.
Whether this is your first time enrolling in Medicare or not, you can contact 2020medicare.us by phone to enroll by calling 844-236-0228.
Be sure to review all the facts about your preferred Medicare Part D prescription drug plan before open enrollment ends on December 7th.