Sunday, December 16, 2012

What You Need To Know About Prescription Drug Plans (Part D)

By B. Loughead
Medicare Part D was created by the passage of the Medicare Modernization Act and went into
effect as of the 1st of January, 2006. If you are eligible for Medicare Parts A and B or already have that coverage, you are also eligible to receive the Prescription drug plans (Part D). If you currently have Medicare, you are eligible to receive this benefit provided you enroll in a Medicare Advantage (MA-PD) plan or a stand-alone PDP (prescription drug plan). The Medicare program approves and regulates these types of plans.

What You Should Be Aware Of With Part D Coverage

You need to be aware that these plans are designed and administered by private healthcare insurers. However, Prescription drug plans (Part D) coverage is not standardized unlike Parts A and B. Each plan selects which medications or classes of medications they are going to cover as well as the level at which they are covered. They also have the right to select those drugs that they do not want to cover. The primary exception would be those medications that are excluded by Medicare coverage.
These include barbiturates, benzodiazepines, and narcotic cough suppressants but are not exclusive to these. Additionally, those plans that cover drugs which have been excluded by Medicare cannot pass the costs of them on to Medicare. If by chance Medicare is billed for these medications, they will refuse payment on them or back-charge the insurer that sent those costs onto them. If you are a Medicaid and Medicare beneficiary, Medicaid will occasionally pay for medications such as benzodiazepines or other types of restricted controlled substances.

The "Donut Hole"

You may or may not have heard the terminology "the donut hole" when researching Prescription drug plans (Part D). This is a gap in insurance coverage that oftentimes occurs once the pre-set prescription medication spending limit has been reached by you and your plan. Not only will your plan quit paying for any further medication expenses once that limit has been reached, there will be a period of time where you will be 100% responsible for payment of your prescriptions.
In closing, you need to keep in mind that there will be a donut hole found in every type of coverage plan. However, the reality is that many individuals never reach the donut hole of their coverage. In addition to this, you may be eligible for discounts on both brand name or generic medications when reaching the donut hole. Fortunately, the donut hole should be phased out completely in 2020.

Summit Medigap is an independent insurance agency that specializes in Medicare supplement insurance. We make Medicare seem easy™. For more information about Medicare supplement insurance visit or call us at 1-888-40-Summit (888-407-8664). **We will provide a Free Part D report specific to your prescriptions to anyone who get's a Medicare supplement plan through us. It will show every plan available in your area and if it covers your prescriptions. It will save you hours of research.

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