07/27/2020
Let's review PART D Prescription drug coverage for Medicare beneficiaries. GA and SC offer 28 stand alone prescription plans.
GENERAL THOUGHTS:
1. These plans must be as good or better than the annual Medicare guidelines for Part D coverage (2020 discussed below)
2. You must have Medicare Part A and/or B to enroll
3. If 65 years old, continue to work and keep employer group health coverage you MAY need to enroll into a Part D plan to avoid a Late Enrollment penalty, IF your current coverage is not considered credible. Medicare requires all Medicare eligible individuals be notified by October 15th concerning their plans coverage status- credible or non-credible
4. Plans vary by state
5. Plans have networks and may have preferred pharmacies for lower cost sharing
6. Medicare Standard guidelines can change each year
7. Each plan has a different formulary or list of covered medicines, as well as exceptions- IE prior authorization, step therapy, quantity limits
8. Medicare Advantage Part C may or may not include drug coverage
9. Extra help is available for individuals with limited income. Extra help assists with premiums, deductible, your costs and you do not enter the GAP phase discussed below. Maximum income and asset caps to qualify change annually.
10. When you have prescriptions filled, you will receive a monthly Prescription Drug Summary. Review and file for review
STANDARD 2020 MEDICARE GUIDELINES
Deductible
annual $435 You pay the full negotiated costs of a prescription
(the plan may not require a deductible for certain covered medicines, or eliminate it all together)
INITIAL COVERAGE PERIOD
You now have co-pay or coinsurance on covered prescriptions If you and the carrier spend a combined $4,020 at any point in the year, you enter the next phase
GAP
Your costs is 25% of the negotiated retail price of covered medicines. You remain in this phase until you have spent $6,350 (Medicare allows the 75% paid on your behalf during this phase to be included toward this maximum out of pocket total)
CATASTROPHIC PHASE
Your costs for covered medicines $3.60 generic, $8.95 name brand or 5% which ever is higher
CLOSING REMARKS
1. Once you are Medicare eligible, Manufactures coupons can not be used. However, you can use prescription discount programs such as Good Rx or a company such as Walmart/Kroger and others $4 list of medicines.. Be sure to inform the pharmacy of your plans. Dollars you spend will not count toward meeting the deductible etc
2. SOME manufactures offer assistance for Medicare beneficiaries while in the GAP phase. You must contact the manufacture and complete an application
3.By the end of September of each year, your current plan is required to send you a packet. Make sure you read the Annual Notice of Changes- this will compare your plan benefits for current year to the following year.
4. Remember this is insurance, so if you have questions contact your carrier customer service.