Medicare Part D FAQs - Allboc Insurance Solutions - Allboc

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Medicare Part D - FAQs
Q: Does Medicare include coverage for prescription drugs?
A: No. If you have Original Medicare and want drug coverage, you may want to think about joining an optional stand-alone Part D plan. This is a private insurance plan that covers prescription drugs only.  Many Medicare Advantage plans already include Part D.

Q: What are Medicare Part D (Prescription Drug) plans?
A: These plans are a voluntary way for people with Medicare to have prescription drug coverage. Most people must enroll to have Part D - it is usually not automatic. The plan may be a stand-alone plan, or be included as part of a Medicare Advantage plan.

What do Part D plans cover? Prescription drug costs only. Each plan has a formulary, or list of drugs it covers. It may have rules about how it covers specific drugs. For certain medications, the plan may have quantity limits, or requirements that you try other drugs first. 
Who can buy Part D plans? Anyone with Medicare Part A, Part B, or both. You also must live in the plan's service area. You can only have one Part D plan at a time. 
What do Part D plans cost? Costs vary widely. Part D plans have a monthly premium, and also can have deductibles and copayments or coinsurance. People with income above $85,000 (single) and $170,000 (couple) pay higher premiums. 
Most plans include a coverage gap (donut hole) after your prescription costs meet a certain amount in the Initial Coverage Level. You may pay a higher coinsurance amount during the coverage gap. You still pay your premiums for Medicare Part B (and Part A, if any). 
Your costs for Part D also can vary widely based on the: 
  • Plan you select 
  • Medications you take 
  • Pharmacies you use to get prescriptions filled 

If you have a late-enrollment penalty for Part D, the plan will add this to your premium.

Medicare contracts with private companies to offer this drug coverage. Premiums, deductibles, co-payments, co-insurance and specific drugs covered vary depending on which drug plan you choose.

Q: Once I choose a Part D plan, do I have to keep it forever?
A: No. You can change plans every fall. Your new plan will start Jan. 1. Some people also get more chances to change, or special enrollment periods for other events (such as moving, losing group insurance, or qualifying for help with costs). To switch plans, just enroll in the new plan (Medicare will notify your old plan). 

Q: What is the Late Enrollment Penalty (LEP)?
A: While Part D is optional, some people who join Part D later than when they first qualify may have to pay a late-enrollment penalty.   

Q: What questions should I ask when selecting a Part D Plan?
  • Are all my medications on the formulary?
  • Do any of my medications have limitations, such as requiring use of tiers, prior approval, step therapy, or quantity limits?
  • What pharmacies can use with this plan?
  • Will I have different costs depending on which ones I go to?
  • What is the monthly premium for the plan?
  • Do I have to meet a deductible before the plan starts to provide coverage? If yes, how much is it? How long does it look like it will take me to reach that amount?
  • What will I have to pay each month for my medications? Will there be any variation month to month, such as when I reach the coverage gap?
  • If I get medications by mail order, will this save me money? Yes No Can I get my medications in 90-day supplies? Will this save me money?
  • What is the total yearly cost to me for the plan (premiums, deductible, co-payments, etc)?

Q: When may I join a Part D plan?
A: If you are turning age 65, you can join Part D in your Initial Enrollment Period, the seven months surrounding your birthday month. If you already have Medicare, you can join Part D every fall from October 15 through December 7. The plan starts Jan. 1. If you have never had Part D drug coverage, or you have had drug coverage which was not as good as Part D, you may have to pay a late-enrollment penalty. You also may have special enrollment periods to join Part D at other times in the year, such as if you lose creditable coverage, move, or if you receive Extra Help such as the Medicare Savings Programs or Medicaid. 

Under age 65 and starting Medicare for disability? 
If yes, you can join Part D plans during the seven months around your Medicare effective month. 

Q: How do I join a Part D plan? 
A: Contact Allboc Insurance Solutions at (920) 858-8752.

Everyone with Medicare, regardless of income, health status, or prescription drugs used, can get prescription drug coverage.
You may sign up for a drug plan during your initial enrollment period when you first become eligible for Medicare (three months before the month you turn age 65, the month you turn 65, and until the end of the third month after you turn age 65). If you get Medicare due to a disability, you will have the same 7 month window of time but it will be based on the month that your Medicare begins. If you don't sign up for a drug plan when you are first eligible, you may pay a penalty when you later start a drug plan.
Q: Are there programs to help me pay for Medicare and my Part D Plan? 
A: Yes. These programs are typically based on your income level. Contact Social Security and/or your state's Medicaid to see if your qualify.

* Contacting us via any of our phone numbers will connect you with one of our employees and/or agents.  Allboc Insurance Solutions is not connected with or endorsed by the United States government or the federal Medicare program.
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