Get all the benefits you entitle to receive at the lowest possible cost.
WE FIND THE BEST PLAN FOR YOU
There is no one size fits all when it comes to prescription plans.
Depending on where you live, you likely have dozens of private plans from which to choose. Plan premiums may range from $0 to more than $70.00 per month.
Each plan has its own deductibles, co-payments, and levels of coverage, including which drugs are covered.
Review Your Part D Prescription Drug Plan
It is highly recommended that you periodically review your Part D coverage, especially if you have started taking new drugs.
3 COVERAGE PHASES
PHASE 1: Initial Coverage
PHASE 2: Coverage Gap "The Donut Hole"
PHASE 2: Coverage Gap "The Donut Hole"
This is the initial phase of coverage until you and your Part D plan have spent a combined total of $4,130.00 on medications.
If you don't take expensive medications, you probably will never get out of the first phase.
PHASE 2: Coverage Gap "The Donut Hole"
PHASE 2: Coverage Gap "The Donut Hole"
PHASE 2: Coverage Gap "The Donut Hole"
2021 Phase 2 begins after you and your Part D plan have together spent a combined total of $4,130.00 on medications.
While in the coverage gap, sometimes called the "donut hole", you will have to pay a larger share of your drug costs.
In 2021, you will pay 25% of the cost of your medications while in the Phase 2 coverage gap.
PHASE 3: Catastrophic Coverage
PHASE 2: Coverage Gap "The Donut Hole"
PHASE 3: Catastrophic Coverage
The coverage gap ends once you have spent $6,550.00 in out-of-pocket expenses in 2021.
It is at this point in which you enter Phase 3 for catastrophic coverage.
WHEN SHOULD I START MY PART D COVERAGE?
You will owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period, you go without a Part D or creditable prescription drug coverage.
The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.
Medicare calculates the penalty by multiplying 1% of the national base beneficiary premium ($33.06 in 2021) times the number of months you didn't have creditable coverage.
EXAMPLE: If you went 10 months without creditable coverage, your penalty would be an extra 10% of $33.06 or $3.30 (rounded to the nearest $0.10) per month in 2021.
Although a relatively small amount, this penalty continues to increase by 12% each year moving forward.
PRESCRIPTION TIERS
Plans sort drugs into "tiers," with drugs in the lower tiers costing less.
Plans typically specify a small co-payment amount for the lower tiers and a co-insurance percentage on the higher tiers.
Each plan is different and will require further investigation.
TIER EXAMPLES
Tier 1: Preferred Generic
Low cost preferred generic drugs and some preferred brand drugs.
Tier 2: Generic
Preferred generic drugs and some preferred brand drugs.
Tier 3: Preferred Brand
Preferred brand drugs and non-preferred generic drugs.
Tier 4: Non-Preferred Brand
Non-preferred brand drugs and non-preferred generic drugs.
Tier 5: Specialty Drugs
A Specialty Tier drug is a very high cost or unique prescription drug which may require special handling and/or close monitoring.
NOTE
The information presented here offers a basic overview of how most of the plans work and does not describe any particular specific plan.
Getting Started with Part D
- Gather an up-to-date list of the names of your drugs and the monthly dosages.
- CONTACT US at 1-800-370-3889 or click the button below to request for help.
On the home page, click on the blue button titled "Find Health & Drug Plans" to get started.
You will have 3 options to choose from:
1. Log in to you Medicare account.
2. Create an online account with Medicare.
3. Continue without logging in.
This step can be a bit tedious if you take a lot of drugs, but worth the effort. Call us at 1-800-370-3889 if you have questions or problems or would like our personal assistance.
When you are done, you will be allowed to save your drug list for later reference. Be sure to write down the "Drug List ID" and your "Password Date" so you can retrieve it later.