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DRUG COVERAGE
The Part D prescription drug coverage is a must for all seniors. Medicare Supplements and some Medicare Advantage plans do not have Part D. Although you do not have to sign up for it there are penalties for not doing so; also, you may not be able to sign up for it at the time you need it in the future.
Medicare Guidelines permit a yearly deductible of up to $310 before you receive full benefits. You are then in the "initial coverage period" and will pay approximately 25% for your medications. When both you and the insurance company has paid $2830 you go into the "donut hole" where you pay 100% of the negotiated medication cost. After your out of pocket costs have reached $4550 will go into "catastrophic coverage" and will pay approximately 5%.
Many plans do not have a deductible and some even offer some coverage through the donut hole.
At Health Plan Advisors we will analyze your prescriptions to find the most cost effective plan for your situation. Any particular medication can be on one of several different "tier levels" with each insurance company. For example, there is one generic medication that cost $2800 per month. Most companies either do not have this drug on their formulary or it is covered as a tier 4 or 5. If you take this medication you will pay around $800 the first month. You are then in the donut hole and paying $2800. There is one company that covers this drug for a $6 co-pay, even through the donut hole. Big difference in your out of pocket cost!
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