| Tue, Aug 23, 2011 @ 09:00 AM

Medicare Part D: Coverage, Costs and How to Sign up

Posted by Medicare Made Clear

Medicare Part D: Coverage, Costs and How to Sign upWhat is Medicare Part D?

Medicare Part D, an insurance plan available through private insurance companies, helps with the cost of prescription drugs. Medicare Part D is not something you are signed up for automatically. If you want it, you will need to enroll in a standalone Part D plan or a Medicare Advantag (Part C) plan that includes Part D.

What does Part D Cover?

The federal government has guidelines for the types of drugs that Medicare Part D plans must cover, and requires a minimum standard for benefits. But that doesn’t mean all plans are the same. They can still vary by the specific lists of drugs covered (called a “formulary”) and the plan’s cost.

To find out what specific drugs a certain plan covers, find health insurance companies that offer coverage in your area and contact them to compare formularies and prices. A good place to start is Medicare.gov’s Plan Finder. Enter your zip code and some other information to get a list of plans available in your service area. Many companies have the information you’ll need on the company website.

What are the costs and benefits?

What you pay depends on the terms of the plan you’ve enrolled in. There will be a monthly premium, and you’ll need to fill prescriptions at a pharmacy covered by your plan in order to use your benefits.

Some plans charge a copay each time you fill a prescription. You could pay a percentage of the cost (coinsurance) each time you fill a prescription.

There are different levels of cost-sharing until you and the plan together have spent a certain amount in a given year on drugs that are included in the plan. Once you and your Medicare Part D plan have collectively spent $2,840 (in 2011*) on prescription drugs, you fall into the “coverage gap.” During the coverage gap, you will never pay more than 93% of the cost of generic drugs or about 50% of the cost of most brand-name drugs, for drug coverage until you reach $4,550 in out-of-pocket costs for the year. Out-of-pocket cost is the total amount you pay for prescriptions with your own funds.

After that, you enter what’s called “catastrophic coverage.” In this stage, you pay a small copay or coinsurance and your prescription drug plan pays the remainder of the costs for each covered prescription drug until the end of the year with no limit.

When can I join and how do I sign up for Medicare Part D?

If you’re entitled to Medicare Part A or enrolled in Part B, you cannot be refused enrollment in a prescription drug plan at the time you become eligible for Medicare. Just sign up during your Initial Enrollment Period (IEP). You can join later, but unless you qualify for an exception (like if you move to another coverage area), you are limited to enrolling only at certain times of the year and you may have to pay a penalty.

You may enroll directly through the insurance company that carries the plan you choose. Many insurers offer phone or online enrollment, or they can send you enrollment forms.

*All the plan details cited in this post are for 2011. Amounts and percentages may change annually. Visit medicaremadeclear.com for updates.

To learn more, contact UnitedHealthcare® Medicare Made Clear at 1-877-619-5582 (TTY 711), 8 a.m. – 8 p.m., 7 days a week. You may also call the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.


Your Guide to Medicare Prescription Drug Coverage

Five ways to lower costs during the Coverage Gap

Watch a short video about Medicare Part D

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