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Private Medicare – Medicare Part D 2019

Compare Medicare Plans – Medicare Gov Part D

Medicare Part D 2019 Open Enrollment

Medicare Part D Open enrollment starts on October 15th to December 7th 2018.

What is Medicare part D?

Private Medicare – Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and has been in effect from January 1, 2006.

Part A and Part B – People are eligible for prescription drug coverage under a Part D plan if they are otherwise entitled to benefits when your enrolled in a Medicare Part A and/or enrolled in Medicare Part B. Beneficiaries can obtain the Part D drug benefits through 2 types of private health care insurance plans:

  • Join a Prescription Drug Plan (PDP) for drug coverage only
  • Join a Medicare Advantage plan (MA) that covers medical services and prescription drugs (MA-PD).

The second type of plan is part of Medicare Part C and has several other differences relative to original Medicare. Almost two thirds of Medicare Part D beneficiaries are enrolled in a PDP option.

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If you have a drug coverage plan now that is at least as good as, or better than Medicare’s basic drug benefit (creditable), and you do like it – you most likely should keep it. If you join a Medicare Part D plan, you may lose your creditable drug coverage and be unable to get it back if you want it later affecting monthly premiums.

Not all drugs will be covered at the same level, giving participants incentives to choose certain generic drugs over others. This is often implemented via a system of tiered formularies in which lower-cost drugs are assigned to lower tiers and thus are easier to prescribe or cheaper for what your plan covers.

You can switch into a new Medicare Part D insurance plan for 2019 during the open enrollment period from October 15 to December 7 2018. Monthly premiums have prices, deductibles, and covered medications that can change each year, so it’s a good idea to reevaluate whether your current plan will still be a good fit for you in the coming year.

If you are enrolled in a health care insurance plan and like your health insurance plans coverage now and are happy with what you have, the best thing to do is call your plan or go online and see how the coverage that you have might be changing,” says Juliette Cubanski, a policy analyst at the Kaiser Family Foundation. “What you have this year is not going to be exactly the same next year.”

Medicare Part D 2018 Open Enrollment If you are enrolled in a plan now and happy with what you have, the best thing to do is call your plan or go online and see how the coverage that you have might be changing,” says Juliette Cubanski, a policy analyst at the Kaiser Family Foundation. “What you have this year is not going to be exactly the same next year.”

Learn more about Medicare Part D

Late enrollment penalty

The late enrollment penalty is an amount that is added to your Medicare Part D monthly premium. Late enrollment penalty may be owed if for any continuous period of 63 days or more after your Initial Enrollment Period is over –

You go without any one of the following plans:

  • Medicare Prescription Drug Plan (Part D)
  • Medicare Advantage Plan (Part C) (like an HMO or PPO)
  • Medicare health plan that offers Medicare prescription drug coverage
  • Any creditable prescription drug coverage

You can pay premiums directly to private insurers or have the monthly premium deducted from your Social Security check.

Employer or union health coverage

You will be notified annually about whether your prescription drug coverage is creditable by your employer or union health coverage is health insurance coverage from you or your spouse’s, or other family member’s current or former employer or union. When you have prescription drug coverage that is based on your current or previous employment, your employer or union. Keep the information you get from them for future reference.

What is the Medicare Doughnut Hole?

Many, if not most Medicare Prescription Drug Coverage Plans will have a coverage gap – also called the doughnut hole. This means there is a temporary limit on what the Medicare drug plan will cover for drugs.

Many will, but not everybody will enter the doughnut hole coverage gap. The 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 will probably change each year. People with Medicare coverage who get Extra Help paying Part D costs will not enter the coverage gap.

Once you reach the coverage gap in 2014, you will pay 47.5% of the plan’s expenses for covered brand name prescription drugs. You only get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.

Although you will pay only 47.5% of the cost for the brand-name drug, the entire price – including the discount the drug company pays – will count as out-of-pocket costs which will help you get out of the coverage gap.

Needless to say – for most people with Medicare Part D, the doughnut hole presents serious financial challenges. Some people have had to choose between their rent or groceries and their prescription drugs.

The Affordable Care Act (2014) has some important changes that will help to relieve this burden for the people with Medicare that hit the doughnut hole each year.

Health Insurance Marketplace

You are hearing a lot about the Health Insurance Marketplace. That’s because the Marketplace Open Enrollment period overlaps with the Medicare Open Enrollment period. The Marketplace is designed to help people who do not have any health coverage. If you have health coverage through Medicare, the Marketplace won’t have any effect on your Medicare coverage.

If you already have Medicare, you are not affected by the Marketplace, but you still get to enjoy extra benefits thanks to the Affordable Care Act like these:

  • If enrolled in par D, a discount of more than 50% on covered brand-name drugs if you hit the Part D prescription drug coverage gap (“donut hole”)
  • A host of preventive tests and screenings — including cancer screenings —  most at no cost to you

What is the Doughnut Hole?

The doughnut hole refers to a gap in prescription drug coverage under Medicare Part D. In 2013, once you reach $2,970 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance,) you will be in the coverage gap. In 2013, you will get a 50 percent discount on brand-name drugs and a 14 percent discount on generic prescription drugs while you are in the coverage gap. When your total out-of-pocket costs reach $4,750, you qualify for “catastrophic coverage.” At that point, you are responsible for only 5 percent of your prescription drug costs for the rest of the year.


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