Wednesday, October 28, 2009

THE MEDICARE PART-D PLAN for 2017

First the Basics.....

Medicare Prescription Drug Plan (PDP or Part D) coverage is insurance that covers prescription drugs outside of a doctor office or hospital stay, not covered by Parts A or B. The Part D is primarily for retail and mail-order pharmacy purchases. The plans are run by Medicare approved insurance companies or other Medicare Provider companies. Each plan can vary in cost and drugs covered. but all plans must meet basic Medicare standards model for drugs covered. Medicare prescription drug coverage provides cost risk protection for people who have very high drug costs and from unexpected prescription drug bills. The Part D Plan's model cost sharing averages are about 75/25 with co-pays still ranging from $0 to $50 and co-insurance co-pays ranging 30% to 70%. The higher priced Plans give people the lower co-pays and co-insurance and immediate, no-deductible coverage. The low-costs plans you have pay the deductible before you are covered. Per Medicare rules, you can change plans any year during ANNUAL ENROLLMENT PERIOD (AEP) Oct. 15 to Dec. 7. Plan changes can also be made during a qualified SPECIAL ELECTION PERIODS (SEP).

REMEMBER: Co-pays are lower, fixed prices and Co-insurance are not fixed costs.. 


All Part D's have their 4 periods: (1) The Deductible Period, (2) The Initial Coverage Period, (3) the non-Coverage Gap (Donut) Period, and (4) the Catastrophic Coverage Period. There are only 2 ways to get Medicare Part D coverage: With a stand-alone Medicare Part D Plan or within a Medicare Advantage Plan (MAPD) that has the Part D built-in the plan. Keep in mind, all Plan D's re-set their coverage amounts renewing each new year on Jan. 1st. 

TO KNOW ABOUT DRUG TIERS & COST LEVELS SEE THIS: CLICK


REMEMBER: NEVER FOOL YOURSELF INTO THINKING YOU DON'T NEED A PLAN-D BECAUSE YOU ONLY USE THOSE $3-$4 GENERICS. POSSIBLY, AT SOMETIME YOU WILL NEED A "BRAND NAME" OR SPECIALTY DRUG. THE FINANCIAL RISK COULD BE VERY HIGH. THERE ARE MONTHLY MEDICARE PENALTIES FOR NOT HAVING A PDP 63 DAYS AFTER YOUR ENROLLMENT PERIOD. GOOD NEWS: THERE ARE QUALITY, AFFORDABLE PLANS FOR THOSE WHO ARE EVEN ON A "McDONALD's" BUDGET. 


NEW FOR 2017

2017 Changes and Discounts in the Part D Coverage Gap (or Donut Hole)

In prior years to 2011, a Plan D member was totally responsible for all costs during the "donut." Again in 2017, pharmaceutical manufacturers will be required to provide qualified beneficiaries who reach the Part D Donut Hole with discounted prices of 51% & 40% of the Part D plan sponsor's negotiated price for brand name drugs and for generic drugs. The discounts are to be applied before other prescription drug coverage under another health plan but after any supplemental benefits provided by the drug plan sponsor. The discounts must be made available to the member at the pharmacy check-out, and the costs paid by drug manufacturers toward the negotiated price must count toward a beneficiary's total out-of-pocket threshold. For 2017 you'll pay 40% for brand-name drugs and 51% for generic drugs during your DONUT-HOLE. These are based upon Medicare average cost and retail pharmacy price.

Part D Defined Standard Model Benefit for 2017

The standard benefit for Part D plans, As the chart below indicates, The annual deductible for 2017 is $400. There will be an increase in the Initial Coverage Limit (ICL) for 2017 is $3700. The deducible $400, initial limit $3700, non-coverage limit $4950, and catastrophe amounts are governed by Medicare for the Drug Provider companies to standardize their plans. The are CMS/Medicare Part D established plan models.

When you and your Part D provider spend to the $3700 threshold, this is a very important number.......IT'S WHEN YOUR NON-COVERAGE, "DONUT-HOLE" BEGINS!!!!!

For 2017, to get out of your non-coverage, donut-hole period you must have total-purchased, out-of-pocket amount of $4950 to regain your coverage. This $4950 is the summation of what you the member and pharmaceutical companies pays during the donut-hole periods and what you spent during initial coverage period..

Once you pay $4950 through your Donut-hole, you go into the Catastrophic Coverage Period where your cost are very minimal, $3.30 for Generics and $8.25 or 5% for Brand-name drugs (the higher/greater of).

REMEMBER: $400 Deductible, $3700 to the Donut, & $4950 to get out of the Donut 



CLICK CHART TO ENLARGE



Medicare Standard Plan limits, periods, thresholds, and standard benefits are established by Medicare/CMS,  NOT BY A COMPANY or PLAN PROVIDER, however your Part D Provider can better the standard Medicare model.

During the "DONUT" non-coverage period medications purchased with a discount card or purchased from non-US pharmacy DON'T count toward getting your coverage re-established to the Catastrophic Coverage Period. These purchases, depending the time of year and drug costs can prolong your non-coverage period. Prescription medications purchased outside the United States is against the law per FDA rules. Never use these methods unless you are certain there no chance of the regaining of your coverage prior to the Dec 31 annual reset of your Part-D. A drug discount card or the buying relationship with foreign pharmacy is never a substitute for a creditable MEDICARE PART D PLAN. Remember, going 63 days without a Medicare Plan D can cause a lifetime penalty!


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Best to your health and saving on your medicines,


THX, Al

Oh, we carry and we're appointed with 5 nationally recognized, approved Medicare Part D Plan providers..

1 comment:

Anonymous said...

ALWAYS UP AND MORE, GLAD YOU EXPLAINED IT THE WAY YOU DO, THX BOB

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