Anyone eligible for Medicare has the opportunity to review, or enroll in a Medicare Part D prescription drug plan during open enrollment.
Why is it important to evaluate your Medicare Part D coverage each year?
Medicare prescription drug plans may change their benefit and formulary designs, year after year. This means your current drug plan may increase your costs, no longer cover your medications, or no longer contract with your local pharmacy for the upcoming year. Therefore, it is very important to review plan offerings during Open Enrollment each year to ensure that you are enrolled in the best plan for you.
How do I know if I'm in the right plan?
You can find a Medicare Part D plan that's right for you if you shop carefully. Here are a few important things to consider when deciding if you are in the right plan:
- Make sure that the drugs you need are on the plan's drug list, called its formulary. Be thorough and check the details. Even if a drug is on the formulary, look closely to make sure it's covered at the dose and quantity you need.
- Compare all the costs. The deductibles, premiums, and copays or coinsurance for Medicare prescription drug plans will be different. Look at the "estimated annual drug costs," which is how much you can expect to pay for the entire year in total out-of-pocket costs, including premiums, deductibles and co-pays.
- Check the pharmacies. Some plans will only work with certain pharmacies. So make sure that your preferred pharmacy is on the list.
It's best to shop around, compare your options and choose the best value for you.
How do I get started?
Comparing prescription plans is easy. Follow these simple steps.
- Make a list of all your prescriptions, including specific dosages and quantities. Your Kinney Drugs pharmacist can easily provide a list of all your prescriptions.
- Go to www.medicare.gov/find-a-plan and follow the simple steps to create your personal Part D Plan comparison.
- The plan comparison will outline the differences in costs and features of all the Part D plans available in your area. Use this information to make a decision about which plan is best for you.
- If you decide to change plans, you can enroll through www.medicare.gov or simply call the plan phone number on your plan comparison. It's that easy.
Where can I get more information?
The more you know, the better equipped you'll be to make important coverage decisions.
Medicare recipients receive the Medicare & You handbook in the mail with more detailed information each fall. This is a good place to start.
You can also:
- Visit your Kinney Drugs pharmacy for help at any time.
- Compare plans using the Medicare Part D Plan Finder at medicare.gov/find-a-plan
- Call 1-800-MEDICARE (1-800-633-4227)
- Find out if you qualify for Extra Help with your premium payments for Medicare Part D. Go to the Social Security website at www.ssa.gov or call 1-800-772-1213.
Medicare Part D is prescription coverage—and if you qualify for Medicare you may qualify for Part D.
Medicare Part D is offered through private health plans to help lower participants' out-of-pocket prescription costs. It can be either a stand-alone prescription drug plan (PDP) or a Medicare Advantage prescription drug plan (MA-PD) that combines medical and drug coverage.
Each Medicare Part D plan has a list of drugs that it covers. Out-of-pocket costs for prescriptions under Medicare Part D are based on the tier on which that drug falls, among other factors. The monthly premium for Medicare Part D coverage varies by plan.
If you are new to Medicare, you can enroll online three months before to three months after your 65th birthday. All Medicare beneficiaries can switch to a Medicare Prescription Drug Plan from 10/15-12/7 each year.
Medicare Part D plans are private companies that cover your prescription medications. If you do not qualify for extra help with costs, you will pay:
- Monthly premiums
- Yearly deductible (if any)
- Co-pay or coinsurance for each prescription (until you hit the coverage gap)
If you do qualify for extra help with costs because of your limited income and assets, you will pay:
- Low or no monthly premiums
- Low or no yearly deductible
- Low or no copays or coinsurance for each prescription
Kinney Drugs accepts most Medicare Part D plans. Our pharmacists can help to find the plan that's right for you.
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Please click on a question below for a full explanation.
Do I have a choice of plan?
Most importantly, you have a choice. All Medicare plans are run by private companies, which release the details of their plans after October 1 of each year. Although all plans must meet the government's requirements, there will be differences between plans, including what drugs are covered and what pharmacies you can use. For example, some plans offer mail-order service. At the end of the year, you can re-evaluate your plan and select a different one if you aren't happy with your current plan.
Plans come in two basic types. The simplest is a prescription drug plan (sometimes called a PDP), which covers only drugs and can be used with your traditional Medicare and/or a Medicare supplement plan. The second type combines a prescription drug plan with a Medicare Advantage plan. This includes medical coverage for doctor visits and hospital expenses. This kind of plan is called a Medicare Advantage plus Prescription Drug, or MA-PD.
What is the best way to choose a Medicare Part D plan?
Opting for the right plan can save you money and benefit your overall health. Following these steps can help prepare you to make that decision:
- Make a list of all of the prescription drugs you currently take.
- Use the Medicare Plan Finder from www.medicare.gov to get a list of the plans that best meet your needs in the area where you live.
- Talk to your local Kinney pharmacist; they can make the process less confusing and help you make the best plan choice to fit your needs.
- When considering what plan works best for you in terms of cost, it is important to consider the following: premiums, deductibles and co-payments.
Am I eligible?
Part D plans are open to everyone who's eligible for Medicare in the U.S. and U.S. territories. Usually, that means people who are 65 years old or older, though some younger people with certain disabilities are eligible too. You cannot be denied coverage for health reasons and participation is voluntary. You get to decide if you want to enroll or not. If you have Medicare and Medicaid, you will be enrolled automatically, so there is no lapse in your Medicaid prescription drug coverage. The open enrollment period is October 15 to December 7, for coverage beginning January 1. There will be annual enrollment periods from then on. If you decide to join later, your monthly premiums may be higher because there's an additional fee for late enrollment.
Is Medicare Part D enrollment required?
No, you do not have to enroll. However, if you do not sign up during your initial enrollment period you will face an incremental late fee should you opt to join at a later date. The late enrollment penalty is an amount added to your monthly Medicare Part D premium. You will owe a late enrollment penalty if, at any time after your initial enrollment period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage. The cost of the late enrollment penalty depends on how long you were without creditable prescription drug coverage.
Do I have to pay to participate?
Participation in Medicare Part D does come with a cost and you will pay a portion of it. Typically, the government pays about 75 percent of the enrollment costs of the plan and you pay the rest.
Are prices discounted if I apply?
When you join a Part D plan, and use the plan's network of pharmacies, you have access to discounted prices on drugs. Plans will negotiate lower prices with drug companies and pass those savings along to you. So when you pay for drugs within the plan, even when you are responsible for 100 percent of the payment, you have access to discounted rates.
How do I enroll in Medicare Part D?
Once you choose a Medicare drug plan, you can enroll in any of the following ways:
- Enroll on the Medicare Plan Finder at www.medicare.gov or on the plan's website.
- Complete a paper enrollment form.
- Call the plan.
- Call 1-800-MEDICARE (1-800-633-4227).
What happens if I enroll late?
If you did not enroll when you were first eligible, you may pay more. The late enrollment fee is approximately one percent of your premium for each month you delay, and you'll pay it for as long as you stay in a Part D plan. If you're late because you were participating in a qualified prescription drug plan, such as a plan from your former employer, the fees may not apply to you. Or if you are eligible for the Low Income Subsidy, the fees may not apply to you.
If you have drug coverage through the Department of Veterans Affairs (VA), and are enrolled in Medicare, you can still obtain your prescriptions through the VA.
Is there a coverage gap? If so, what will I pay?
Most Medicare prescription drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2013, once you and your plan have spent $2,970 on covered drugs (the combined amount plus your deductible), you're in the coverage gap. This amount may change each year. People with Medicare who get Extra Help paying Part D costs won't enter the coverage gap.
Once you enter the coverage gap, you get a 52.5% manufacturer-paid discount on covered brand-name drugs. Although you'll only pay 47.5% of the price for that brand-name drug, the entire price will count as out-of-pocket costs, which will help you get out of the coverage gap.
What if I can't afford a premium or monthly copays?
You may qualify for Extra Help if you have up to $17,235 annual income ($23,265 for a married couple). Some people with limited income and resources will qualify for Extra Help. If you qualify, Social Security will help you pay for premiums and/or the cost of prescriptions. You can apply for Extra Help at any time, and there's no risk to submitting an application. To determine if you qualify, contact your local Social Security office, or visit www.ssa.gov for more details. To qualify for this subsidy in 2013, Medicare-eligible seniors must meet specific income guidelines. The "Extra Help" benefit will help qualifying seniors by reducing or eliminating out-of-pocket deductibles, co-pays and expenses associated with the coverage gap.
Please click a Medical Term below to see the full definition.
Annual Election Period (AEP)
October 15 through December 7, which is generally the only time of each year that you can change plans (unless you meet certain special exceptions, such as moving out of your plan's service area or you are covered by Medicaid).
The percentage that you pay for a covered drug. With some plans, you do not pay coinsurance until you have first paid a deductible.
This is the set amount you pay for each covered drug. Different co-pays may apply depending on the type of drug (brand or generic) or days supply (30 or 90). See "Drug Tiers."
Amount you pay for Medicare prescription drug coverage after the initial coverage limit and until the amount you pay out of your pocket for covered prescription drugs reaches a certain limit. This amount changes each year and is also known as the "true out-of-pocket" or "TrOOP" limit. The Coverage Gap is sometimes referred to as a "Donut Hole."
Drug coverage that is at least as good as Medicare prescription drug coverage.
A set amount of dollars you must pay before you receive coverage for your benefits.
See "Coverage Gap."
Drug tiers allow plans to group different types of drugs together on their preferred drug lists (such as generic drugs, brand-name drugs, or preferred brand-name drugs). For example, a two-tier pharmacy plan will have two different co-pay options. The lower copay may apply to generic drugs, and the higher co-pay may apply to brand-name drugs.
A list of drugs covered by a health insurance plan. This list must always meet Medicare's requirements and is sometimes called a "Preferred Drug List."
Monthly Plan Premium
The payment you make to a health insurance company for your health plan.
A drug that typically requires a higher copay than a preferred drug.
The increased amount you may pay if you do not apply for Part D (Medicare prescription drug coverage) when you are first eligible.
If you don't join when you are first eligible, and you don't currently have a drug plan that is at least as good as Medicare prescription drug coverage, you may pay a penalty that increases the cost of the monthly premium by one percent for every month you wait to join.
A drug that typically requires the lowest co-pay.
True Out-of-Pocket (TrOOP)
Amount you pay during the "Coverage Gap." This amount changes each year and may be paid by another person, or a qualified State Pharmaceutical Assistance Program (SPAP), on your behalf.