3 Things You May Not Know About Medicare Part D

Along with falling leaves, dried cornstalks and carved pumpkins, October ushers in Medicare Open Enrollment season (Oct. 15- Dec. 7). So as you get ready to greet trick-or-treaters, you might also want to brush up on your Medicare benefits.

Many people take at least one prescription medication every day, so Medicare Part D prescription drug coverage and costs may be a top concern. Here are 3 things you may want to consider as you review your current Part D coverage, research different plans or estimate your drug costs for 2015.

1. Split-tier deductible plans: If your Part D plan has a deductible, you pay the total cost of your drugs until you reach the deductible amount set by your plan. Some plans may have a deductible for only specific drug tiers. For example, your plan may have a deductible for higher-tier drugs and no deductible for lower-tier drugs. In this case, your plan coverage for a lower-tier drug would start with the first prescription you fill, but you would pay the total cost of higher-tier drugs until you reached the deductible amount. Then your plan coverage would kick in. It’s important to understand a plan’s drug formulary, tier system and cost structure in order to estimate and compare costs.

2. Coverage gap (donut hole) costs: You may know about the coverage gap and that you pay more for your drugs if you enter it, but did you know your costs in the gap are going down? In 2015, you will pay 45% of your plan’s cost for covered brand-name drugs and 65% of your plan’s cost for covered generic drugs (down from 47.5% and 72% in 2014, respectively). Not everyone will enter the coverage gap because their drug costs won’t be high enough. But if you do, you can look forward to more savings in 2015.

3. Extra Part D premium amount: You might pay an extra amount in addition to the plan premium for Part D coverage if your income is above the limit set by Medicare. The income limit is $85,000 for single individuals and married individuals filing separately or $170,000 for married couples filing jointly. The extra amount you may pay will vary depending on your reported income, but it would be the same for any plan (though each plan sets its own base premium and these can vary). The extra payment may be deducted from your Social Security, Railroad Retirement, or Office of Personnel Management check along with other premium payments, or you may be billed if you don’t get any of these benefits.

Remember, you can change your coverage choices during Open Enrollment, Oct. 15 – Dec. 7. Making changes is easy. Usually you can simply enroll in a new drug plan, if you choose to do so. You will automatically be dis-enrolled from your previous plan. If your previous plan was a Medicare Advantage (Part C) plan that includes drug coverage, you will be dis-enrolled from that plan and will get your coverage through Original Medicare instead. In this case, you may also want to consider a Medicare supplement insurance plan to help with some of the costs that Original Medicare doesn’t pay.

For more information, contact Modern Insurance Marketing, Inc. and/or Senior Choices NW with all of your questions about your coverage.  We'll make it easy for you and save you a whole lot of hassles!