In need of Medicare Prescription Coverage?
We at Health Plans in Oregon have talked about the differences between the different parts of Medicare before, specifically, Medicare Part D coverage. Simply stated Medicare prescription coverage (Part D) is for covering prescription medications. But there is a little more complexity about Plan D that should be broken down.
Most basic or model 2020 Medicare Part D plan is broken down into four main parts:
• Part 1 – The initial $400 deductible – Some plans do not have an initial deductible and provide “first dollar coverage”
• Part 2 – Coverage – The plan provides the Medicare Part D Beneficiary with co-insurance or medication co-payment. Usually, coverage extends to a point where the total retail cost of the medication reaches $3700. However, some plans lower this limit to $2,000 or even $1,850 (lower limits are used to lower monthly premiums for people with minimal medication needs).
• Part 3- The Coverage Gap or Donut Hole – Here is where the Beneficiary pays 100% of their Medication costs. Some plans do provide partial or complete coverage for this gap in the
Medicare prescription coverage.
• Part 4 – Catastrophic Coverage – When a person has spent more than $4950 for prescription medications, they will be protected by this coverage. Here, the cost of medications is substantially reduced.
>>> Click to see Explainer Video
The costs of your Medicare prescription coverage vary depending on:
• The drugs you use
• The plan you choose
• Whether you go to a pharmacy in your plan’s network
• Whether the drugs you use are on your plan’s formulary
• Whether you get Extra Help paying your Medicare Part D costs
Always check the list of covered drugs in your chosen plan, including information about the drug formulary (list of covered prescription drugs which contains all the covered drugs) and tiers. This is to save on drug costs and to fully utilize your chosen policy.
Formularies may change at any time and you’ll be notified by your Medicare plan if necessary. However, Medicare Prescription Drug plans (Part D) are restricted from making changes to the listed drugs or even make a change on the tiered pricing –this restriction course is between the beginning of the plan’s annual election period until 60 days after the plan’s coverage begins.
There are drugs that are not covered under Medicare Part D.
Each Medicare prescription coverage policy decides which drugs not to cover on its formulary, the list below are some drugs that are not covered (not a complete list).
• Drugs for cosmetic purposes or hair growth
• Weight loss or weight gain drugs
• Fertility drugs
• Drugs for sexual or erectile dysfunction
• Over-the-counter drugs
• any drugs that are covered under Medicare Part A or Part B.
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