Medicare Part D
Prescription Drug Plans
Please note this is general information only - For Detailed Plan Information
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The annual Medicare Advantage and Medicare Part D Prescription plan open enrollment has changed for 2011. It is from 10-15-2011 until 12-07-2011. During this period anyone on Medicare whether over age 65 Medicare or under age 65 disability Medicare can sign up for a Medicare Advantage or Medicare Prescription plan. This is truly an open enrollment period where you have freedom make changes. In this period you do not need a reason, you just can change because you want to. During this time, AEP, Medicare beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1.
News for people on underage Medicare disability.
Starting October 1, 2009 Insurance Companies offering Medicare Supplement Plans in Florida must also offer the Medicare supplements to people on Medicare due to disability. There is a limited open enrollment period. Please contact me immediately for information on underage Medicare supplements so you can decide if that is best for you. Please click on the button below to receive information on underage Medicare Supplement plans.
I have information on underage 65 disability Medicare Supplement Plans available.
Medicare Part D Prescription Drug Coverage
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.
Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.
You may sign up when you first become eligible for Medicare (three months
before the month you turn age 65 until three months after you turn age 65). If
you get Medicare due to a disability, you can join from three months before to
three months after your 25th month of cash disability payments. If you don't
sign up when you are first eligible, you may pay a penalty. If you didn't join
when you were first eligible, your next opportunity to join will be from
November 15, 2008 to December 31, 2008.
Your decision about Medicare prescription drug coverage depends on the kind of
health care coverage you have now. There are two ways to get Medicare
prescription drug coverage. You can join a Medicare prescription drug plan or
you can join a Medicare Advantage Plan or other Medicare Health Plan that offers
drug coverage.
Whatever plan you choose, Medicare drug coverage will help you by covering
brand-name and generic drugs at pharmacies that are convenient for you.
Like other insurance, if you join, generally you will pay a monthly premium,
which varies by plan, and a yearly deductible. You will also pay a part of the
cost of your prescriptions, including a copayment or coinsurance. Costs will
vary depending on which drug plan you choose. Some plans may offer more coverage
and additional drugs for a higher monthly premium. If you have limited income
and resources, and you qualify for extra help, you may not have to pay a premium
or deductible.
Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.
 | Deductible – A deductible of $320. You usually pay all of your drug costs, up to $320. After you have paid $310 deductible for your drugs, you usually pay 25%, the plan pays 75% of your prescription drug costs up to the coverage limit of $2,930. |
| Initial Coverage Limit – The coverage limit is $2,930. In this part of the plan, the plan pays 75% of the prescription costs up to the coverage limit of $2,930 in shared cost. Once this limit is reached for prescription drugs, your coverage is 14% for generics and 50% for brand name prescriptions. You are responsible for paying 50% of the brand name drugs and 86% of the generic drugs until your true out of pocket costs (TrOOP) are met. This period is known as the Coverage Gap or Donut Hole. |
| TrOOP - True out-of-pocket costs (TrOOP) are costs (annual deductible, if applicable, and copayments, coinsurance and Coverage Gap expenses for covered drugs) for which the member is not reimbursed. Premiums do not count towards these costs. 100% of the 50% brand discount and 50% coinsurance counts toward the TrOOP. On generics drugs, only the 86% coinsurance counts toward the TrOOP |
| Catastrophic Coverage – Once you have reached the out-of-pocket costs of $4,700, you qualify for catastrophic coverage. Catastrophic coverage assures that once they have spent up to the plan’s out-of-pocket limit for covered drugs, they only pay a small coinsurance amount or a copayment for the rest of the year. For 2012, the catastrophic coverage period begins once the member pays $4,700 in true out-of-pocket costs during the year (January 1 initiates a new cycle starting with the deductible). The member pays the greater of 5% of the total medication cost or $2.60 for generics and $6.50 for brand name drugs. |
| Coverage Gap or Donut Hole - This is when you would be paying 14% of your generic prescription drug costs and 50% of your brand name prescription costs you qualify for catastrophic coverage. |
| Formulary - A list of medications covered with the benefit plan; often represents the level of cost sharing associated with various groupings of medications (Generic, Preferred Brand, Non-Preferred Brands). The published lists usually only show the Preferred Brands or Preferred Drug List. |
| Late Enrollment Penalty - If the member does not enroll during his/her initial eligibility period, a penalty of 1% of the national average Medicare Part D premium is assessed for each month the consumer delays enrollment. The Late Enrollment Penalty is a Medicare requirement and cannot be waived or changed by the plan. Unless the member qualifies for an exception, such as having creditable coverage, the penalty is added to the monthly premium and is paid as long as the member is enrolled in any Medicare Part D plan. (Members who are deemed low-income subsidy are not assessed a late enrollment penalty.) |
| Late Enrollment Penalty Example - If a consumer becomes eligible for Medicare Part D in the initial election period. They have three additional months (until the end of May) to enroll in a Medicare Part D Plan. If they do not enroll, a 1% per month penalty will begin to accumulate. By year-end, 7 months will have passed (from June to December is seven months) 7 x 1% = 7%. If this consumer fails to enroll during the next Annual Election Period, he will not be able to enroll for another twelve months. To calculate the penalty, add 12% for one year to the original 7%. This adds up to 19%. The 12% per year penalty will continue to accumulate until enrollment. |
