Prescription Drug Coverage (Part D)

 How do you know which Part-D Drug Plan or Advantage Plan to enroll in? With our quoting tools, we will show you the bottom line. Which plan covers your drugs the best and minimizes your out of pocket. 

Most Medicare Advantage Plans will have Part D included. Not all plans cover drugs the same. Some cover certain medications better than others. On one plan you could have $2,000 worth of annual prescription copays, while on another you could only have $500 out of pocket. We keep it simple and show you the bottom line, which carrier and plan covers your  medications the best. Being cost effective goes a long way in saving you money.

If you take out a Medicare Supplement Plan, you will need a seperate stand alone drug plan. How do you know which Part-D plan to get? Give us a list of the Prescriptions you take including dosage and frequency, and we'll identify the best drug plan for you in your zip code based on your prescription list. 

It's important to review your drug coverage each year during the Annual Election Period -October 15th - December 7th

-It's important to review each year because:

1. You could be taking new medication we haven't accounted for
2. Your drug coverage is changing, and your current medications will be covered differently the following year
3. Changes in legislation/CMS regulation

Since Part D plans are offered by private insurance carriers, there is no one standard premium. Instead, the premium will depend on the plan’s carrier and coverage. Most Medicare Advantage plans also offer prescription drug coverage as part of the plan, so individuals enrolled in one of those plans will not have a separate premium for Part D.

The total cost for Part D will depend on the following factors:

• The plan’s specific premium and deductible
• If the prescription drug coverage is a stand-alone Part D plan or as part of a Medicare Advantage Drug Plan (MAPD)
• If the individual receives financial assistance from the Extra Help program
• The medications each individual takes and how often they are refilled
• The pharmacy used
• If the medication is covered under the plan’s drug formulary

-Ask to determine which IRMAA bracket you fall into. 

The five prescription drug tiers:

1. Preferred generics
2. Generics
3. Preferred brands
4. Non-preferred drugs
5. Specialty drugs

Medicare has its own rules on late and missed payments, but it is ultimately up to an individual’s plan on how to proceed with late payments.

According to the rules set by the Medicare program, if an individual is late in paying a premium, they can still receive coverage without a penalty. They are also granted a grace period along with warnings and notifications about the late or missed payments. Medicare will send the beneficiary a letter by mail instructing them to contact their plan’s carrier about the payment.

No matter the carrier, individuals must be notified before the carrier drops them from the plan. Grace periods must be allowed for a minimum of two months, but some plans offer an extended grace period. The grace period will begin on the first day after the payment is due.

Plans with a Single Grace Period may disenroll individuals who miss one or more premium payments during that grace period. The individual will be dropped from coverage at the end of the timeframe that was allotted.

Plans that have a Rollover Grace Period allow their members to stay enrolled if they owe more than one month’s premium but pay for at least one premium during the grace period. If this occurs, a new grace period will begin. However, if no payment is made, the carrier may disenroll the individual from the plan.

Insurance companies will send notifications to members who have failed to pay their premiums but will disenroll any member who fails to make a payment during the grace period.

Once an individual has been disenrolled from a plan, they will have to submit an application for coverage.