Medicare Part D RX Plans

How do you know if the drugs you currently take will be covered by a Medicare Part D Plan?

All Part D plans must meet formulary requirements set by Medicare. The formulary includes brand name as well as generic drugs. To establish the formulary, each prescription drug plan must use a Pharmacy and Therapeutic Committee, including a team of doctors and pharmacists. The formulary assures that you have access to these drugs, although it might not necessarily include all available drugs.

Each Medicare Part D plan’s formulary can usually be found on the insurance provider’s web site, or by contacting their customer service. You can also get information by visiting Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).

Drugs that are excluded from Part D by Medicare are:

• Drugs for anorexia, weight loss, or weight gain
• Fertility drugs
• Drugs for cosmetic purposes
• Drugs for hair growth
• Drugs for the symptomatic relief of cough and colds
• Prescription vitamins and mineral products (except prenatal vitamins and fluoride preparations)
• Non-prescription drugs
• Barbiturates (sleeping pills)
• Benzodiazepines (central nervous system depressants)
• Inpatient drugs
• Drugs purchased outside the US

Also, a drug cannot be covered under your Medicare Part D plan if the payment for that drug is available under Parts A or B of Medicare, for example drugs you receive in a hospital or at a physician’s office.… Read more

You can get Medicare Advantage plans with Part D prescription drug coverage. Co-pays and limits apply.

If your current plan does not offer Medicare Part D drug coverage, you may want to enroll in a Medicare Advantage Plan that does provide Part D prescription drug coverage.… Read more

Medicare Part D Prescription Drug Plans have a temporary limit on the amount that is paid for Medicare approved medication. This limit is called the ‘coverage gap’, also referred to as the ‘donut hole’.

The ‘donut hole’ starts after you have purchased a certain amount of prescribed drugs that are covered by your plan. It lasts until you reached a specific total out-of-pocket cost amount. While you are in the whole, your plan will cover 14% of the cost of generic drugs and 50% for brand-name drugs (in 2012). The total amount of the retail price that your Medicare prescription plan provider has negotiated with the manufacturer counts towards your out-of-pocket spending, which will help you get out of the coverage gap sooner.

If you have very high drug costs, all Medicare drug plans provide ‘catastrophic’ coverage. Catastrophic coverage means that once you pay a certain amount out-of-pocket for drug costs, the plan will cover almost all your drug costs above that amount.

As all Medicare drug plans are different and the above are only a brief basic description of the more complex rules, you need to contact your plan provider for more details how the coverage limitation works in your plan.… Read more

Before we answer this question, let’s first explain: What exactly is the Medicare Part D donut hole?

The donut hole describes the situation that seniors, who rely solely on a Medicare Part D drug prescription plan without additional private prescription drug insurance, and spend a lot for medication, will have to pay 100% of their prescription drug costs instead of the initially low copay, once the total cost of their annual prescription drugs reaches the annual limit that is set by Medicare ($2930 for 2012).

Here is how it works: Let’s assume you have a Medicare Part D prescription drug plan, but no other insurance that would cover costs for medication, and your doctor describes you a lot of expensive medication. Every month, you pay your premium. When you get prescription drugs that is covered by your plan, you plan pays its share, and you pay your share (the deductible, if you plan has one, and your co-payment or co-insurance). The actual numbers depend on the plan you choose.

During the year, the total cost of your prescriptions (this is the retail price of the medication that your plan has negotiated with the drug company), reaches the annual ‘threshold’ ($2,930 for 2012).… Read more

Seniors with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.

Here is how Medicare Part D coverage works:

• You pay out-of-pocket for monthly Part D premiums all year
• You pay 100% of your drug costs until you reach the deductible
• After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches the current limit for the year
• Once you reach this limit, you have hit the coverage gap referred to as the ‘donut hole‘, and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit
• After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs

There are some Medicare Part D plans that offer coverage in the donut hole, but these plans may charge a higher monthly premium. There are also some Part D plans that offer fixed co-pays (e.g. $10 or $20) for prescription drugs instead of the deductible and 25% cost-sharing that was described above.… Read more

You know that if you only rely on the original Medicare program, your prescription drugs won’t be covered. Next to prescription drug plans which also offer coverage at a reasonable cost, there are drug discount programs. The Anthem Discount Card Program is one of them.

So what are the benefits of Anthem’s Medicare-approved drug discount card program versus Anthem’s current medical drug coverage?

Here is how it works: Members with Anthem’s medical and drug coverage already receive discounts on prescriptions through their medical plan, even after drug benefits are exhausted.

Although Anthem’s Medicare-approved drug discount card discount cannot be combined with a member’s current drug coverage discount at the retail pharmacy, it may be beneficial for drugs not covered or medication with limited coverage under the member’s drug plan. Make sure to compare the discounts that are available through this program, before you decide if a Medicare-approved card is good for you.

Members who enroll in Anthem’s Medicare-approved drug discount card program should consult with their pharmacist on whether the Medicare-approved card, or the medical drug benefit plan has a lower out-of-pocket cost for the medication you need.

For more information, visit www.Anthem.com

… Read more

Each year, during the Open Enrollment period at the end of the year, anyone who is receiving Medicare has the opportunity to change, switch or join a plan during the Medicare Part D Open Enrollment.

Having Medicare Prescription Drug Coverage in the Medicare health plan can be very important as people get older and develop the need for costly medications.

In order to participation in the Medicare Prescription Drug Plan you must have Medicare Part A or Medicare Part B. You also must live in the service area of the Medicare Prescription drug plan that you want to join and, if you have a current provider for your Medicare plan, a discussion with the provider will be helpful.

You will want to compare the costs of the coverage since insurance and private providers that are approved by Medicare have plans that vary in cost. People receiving medical coverage through their retirement plan should discuss Part D with their benefits administrator because there are sometimes internal policies with union retirement plans that will not allow you to make the change to Part D.

Changing coverage or adding prescription drug coverage during the open enrollment period will not have a fee associated with it.… Read more

When Do I Have To Pay A Late Penalty For My Medicare Part D Prescription Drug Plan?

One of the worst surprises for someone on Medicare are unexpected costs. The prescription drug benefit is voluntary, but if you don’t enroll when you first become eligible, you may have to pay a hefty late enrollment penalty if you choose to sign up at a later date.

You are charged an extra 1% of Medicare’s national average drug insurance premium for each month that you did not have prescription drug coverage as good as Medicare’s but could have.

If you have other coverage, the person who administers your benefits will tell you whether your coverage is creditable, meaning comparable to Medicare’s coverage. The 1% percentage will grow until you enroll in a drug plan.

Here is An Example: Anne turns 65 in February. She has through May (three months after she turns 65) to enroll in a plan without penalty. Although she has no other drug coverage, Anne chooses not to enroll in a prescription drug plan.

In August, she becomes ill and decides that getting drug coverage now would be a good idea, but she can’t enroll until the next ‘enrollment’ opportunity, which is October 15, 2011 – December 7, 2011.… Read more

In case you are not familiar with Medicare Part B: Medicare part B is the part of your Medicare insurance that covers medical procedures such as doctor visits, outpatient care, home health care and some preventive care. It also includes prescription drugs, but on a very limited basis. ‘Self administered drugs’, typically the kind of medication you get prescribed by your doctor to take at home, are not covered.

The kind of medication that is covered are specific Medicare-approved injections and vaccinations you receive at your doctor’s office, specific cancer drugs, and a few drugs that are necessary for some types of medical equipment, such as an external infusion pump. Under certain circumstances it also covers some medication you receive in a hospital as outpatient. In any case, Medicare only pays its usual share of 80%, and the patient has to come up with a co-payment of the remaining 20% – unless the costs are covered by optional added Medicare prescription drug insurance, such as Medicare advantage plans or Part D Prescription drug plans.

This means, for most prescribed drugs, you have to pay 100% out of pocket, if you solely rely on Medicare Part B and don’t have another drug coverage plan.… Read more

When selecting a Medicare Part D plan, it is important to make sure that you will receive the benefits you need. So before you enroll, you need to find out if your prescriptions are covered by the plan, if it includes doctors, hospitals and pharmacies in your area and whether your health care provider accepts the plan.

Aetna Medicare offers three different Part D plans that provide Rx coverage in each state. You can choose between two different plans, the Essential and the Premium plan. In most states, you can also select a third option, the CVS/pharmacy Prescription Drug Plan.

More than 65,000 pharmacies are part of the national network. The Aetna Medicare Part D Rx plans have many benefits and cover most Medicare-approved prescription drugs, but some limitations, such as prior authorization may apply. All plans offer currently $0 deductible for generics, but only the Premier^® Plan has a $0 deductible for brand name drugs.

Aetna Medicare Rx Plans are a popular choice, because they they help seniors manage their prescription drug costs with predictable co-payments, and give you piece of mind in case your prescription drug needs may change in the future.

Frequently Asked Questions about Aetna Rx Plans:

Is My Pharmacy Included?… Read more