This means that select plan holders can take advantage of $0 copays. And while you may qualify for the $0 copays, it’s important to see whether your Medicare Plan D is the right one for you. Start by comparing plans to see if you are getting the most out of your coverage.
Medicare is health insurance offered by the federal government to people who are 65 and older and to some younger people with disabilities.
Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home-health care. Beneficiaries must meet certain conditions to get these benefits.
Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.
Medicare Part B helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home-health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.
Medicare Part C is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare
The Medicare prescription drug benefit offers coverage for brand-name and generic drugs to anyone eligible for Medicare. Coverage is provided through private insurance plans, and you can choose a plan that is right for you. Please note: You must enroll to get coverage.
To be eligible for the Medicare prescription drug plan, an individual must be:
You should enroll in a Medicare Prescription Drug Plan unless your current drug coverage is as good as (or better than) the Medicare prescription drug coverage available to you. This is called “creditable” coverage, and it is important that you join a plan when you are first eligible. You should contact your current plan provider to determine if you have creditable coverage. If you are eligible for Medicare and have Medicaid, you may be automatically enrolled in a prescription drug plan. Check with your state’s Medicaid department for more information.
You have the opportunity to obtain drug coverage when you become eligible for Medicare, during your initial Medicare enrollment period. You can join a Medicare drug plan:
Once you choose a Medicare drug plan, you can enroll in any of the following ways:
If you don't join a Medicare drug plan when you're first eligible to join (during your initial enrollment period), you may have to pay a late-enrollment penalty when you join. This amount changes every year but is approximately 1% of the plan's premium price for each month you delay enrolling. In addition, you will have to pay a penalty as long as you have Medicare prescription drug coverage.
You'll make these payments throughout the year when you have a Medicare drug plan:
Your actual drug plan costs will vary depending on:
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 also help seniors by reducing or eliminating out-of-pocket deductibles, copays and expenses associated with the coverage gap.
Following these steps can help prepare you to make a decision:
If you're currently enrolled in a Medicare Part D plan, you should think about a few things to decide if you are in “the right plan”. Each year, plan premiums, deductibles, prescription copayments and annual out-of-pocket expenses can change. These costs, as well as the list of covered drugs, vary from plan to plan and from region to region. You also need to remember that, in general, only the cost of Part D-covered drugs that are included on a plan's formulary count toward the deductible and out-of-pocket limits.
You should take time to review the various plans available to you in light of your current and anticipated prescription needs and financial resources. You may want to consider whether there is a different plan available that may be more suitable to your needs. Use the Medicare Plan Finder at www.medicare.gov to help compare.
In 2013, pharmaceutical companies will provide a 52.5% discount on brand-name drugs and a 21% discount on generic drugs filled during the coverage gap. Additional savings on generic prescriptions also are available during the coverage gap.
The 52.5% discount on brand-name drugs works as follows: 50% from the pharmaceutical copay, 2.5% from the Medicare Part D plan and 47.5% from the customer or beneficiary would be applied toward the total out-of-pocket cost through the coverage gap. So if a customer has a prescription drug that costs $400 a month at the agreed-upon price, $200 will be paid by the pharmaceutical company, $10 will be paid by the Medicare Part D plan and $190 by the beneficiary, but $400 will count toward the customer's total out-of-pocket expense.
Be advised: In order for the brand-name drug to be included, the pharmaceutical company must sign an agreement with Medicare. If there is no agreement for a particular drug, it is NOT entitled to the 52.5% discount.
Each year, Medicare recipients receive the “Medicare & You” handbook. It includes more detailed information and is a good place to start. You also can visit: http://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html
*Note: This links to www.medicare.gov, a website hosted by the Centers for Medicare and Medicaid Services (CMS).
Call 1-800-MEDICARE (1-800-633-4227).