Archive for the ‘medicare part d’ Category

Medicare Part D – Overview, eligibility, coverage, and enrollment

Friday, February 3rd, 2012

Overview and eligibility

Medicare Part D is the prescription drug part of the Medicare program. It came into being as the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Act of 2003). Part D, also known as a Prescription Drug Plan (PDP), is a voluntary drug plan that is available to all Medicare recipients who have either Part A or Part B. It is available through private insurers that are approved by and contracted with Medicare.

Essentially, there are 2 ways to get prescription drug coverage under Medicare:

  1. Stand-alone drug coverage plans can be added to the basic, Original Medicare. They can also be added to certain Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. HMO and PPO Medicare Advantage plans include prescription drug coverage in their plans. Remember, you must have both Part A and Part B in order to qualify for a Medicare Advantage plan.


Most insurance companies offering Part D are allowed to design their own drug plans, so coverage will vary from plan to plan. Specific coverages are extensive and complicated, but in general the “basic Part D” meets the following conditions:

  • The annual deductible can’t be more than $310 for 2011.
  • The plan must cover at least two drugs in each drug class.
  • The plan must cover substantially all drugs in these six categories: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatments), anticancer drugs, and immunosuppressants.
  • Members must be able to seek an exception if a drug is medically necessary but not covered under the plan.
  • Plans must have a network of pharmacies that provide convenient access.
  • Lists of covered drugs and pharmacy networks must be readily available to members.
  • Plans must work with nursing homes.
  • Plans must help transition a member’s current drug coverage.
  • Plans must offer catastrophic coverage that is at least as good as the coverage outlined in the 2003 Medicare Act.





Medicare Part D has both standard enrollment periods and special enrollments. There are also late enrollment fees that Medicare participants may encounter.

Those signing up for the first time can do it in one of 4 different ways:

  1. Sign up during the Initial Enrollment Period (IEP). As mentioned in previous articles, the initial enrollment period for most individuals begins at 65. If you’re eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  2. You can join, switch, or drop a prescription drug plan during the Annual Coordinated Election Period (AEP). This period runs from October 5th to December 7th. Any changes made during this time will take effect on January 1st of the following year.
  3. If you get Medicare due to a disability.
  4. If you get Extra Help, a special program offered by Medicare and Social Security for participants with low income and limited resources


Generally, participants are required to stay with a plan for a calendar year, but sometimes individuals with extenuating circumstances may be able to join, switch, or drop their plans during Special Enrollment Periods (SEP). If you move out of your plan’s coverage area, lose other prescription drug coverage, or if you live in a nursing home or personal care home, you may qualify for SEP.

Late enrollment penalty:

If your initial enrollment period lapses for 63 days or more in a row, when you do not have Part D or another approved medicare prescription drug coverage plan, you will be charged a late enrollment penalty. This penalty is approximately 1% of the average national premium, for each month that you delay enrolling in a Part D. This amount is rounded to the nearest $.10 and added to your monthly premium.


Sources used in this article

Using Pennsylvania Medicare Supplement Insurance

Monday, September 19th, 2011

It seems Medicare beneficiaries deal with more and more complicated issues on a daily basis.  There are hundreds of choices for plans which compliment basic Medicare coverage, and for those living in the state of Pennsylvania, several Pennsylvania Medicare supplement insurance choices are available.  Most beneficiaries already have a supplementary plan, but may not understand the proper use of these plans.

Most Pennsylvania Medicare supplement insurance plans work with your Medicare benefits to provide extra coverage for expenses.  The problem is, not all of these plans work the same way and not all plans will provide 100% coverage.  It is important that beneficiaries understand their coverage and which insurance plans are available to them before incurring medical expenses.  A full understanding of your Pennsylvania Medigap insurance coverage will help you avoid surprise expenses after visiting a doctor or obtaining medical supplies.

To learn about your plan, read through your policy materials, or call the customer service line for your Pennsylvania Medicare supplemental insurance plan.  Ask the following questions regarding the policy:

– Does the plan cover 100% of any copay after Medicare pays?  If it doesn’t, you will have to pay some of the expenses, so find out what it does cover.  A common set up is for the Pennsylvania Medigap plans to cover 80% of charges after Medicare.  So, if the charge was $100, Medicare might pay $80 and put $20 toward a copayment.  The supplemental insurance would pay %80 of the $20.  This means they pay $16 and you pay $4.  This doesn’t sound like much, but the expenses can mount quickly if you are not aware of them.

-Does the plan cover deductibles.  Medicare has an annual deductible of $110 for its Part B benefit.  This is the benefit that covers visits to the doctor, some supplies and other outpatient procedures.  If the plan does not cover deductibles, you will have to pay this amount each year before your insurance kicks in.

-Does the plan pay for items that are non-covered under Medicare’s Part B benefit?  Some services and supplies are not covered at all under Medicare.  A very good supplement insurance will also pick up some charges for these supplies, although the majority of these plans will only follow after what Medicare actually pays for.

-Does the plan offer a Pennsylvania Medicare Part D Coverage?  You should always know if you have a drug benefit associated with your insurance, because it can save you a great deal of money at the pharmacy!  Standard medical insurance policies hardly ever cover prescriptions, so ask about this benefit before purchasing insurance.

-What providers can you use under the plan?  Generally, most supplemental insurances will pay for services provided by any Medicare eligible provider.  However, there are some plans which operate under a managed care environment, and providers must contract with them.  Make sure your doctor is contracted with the plan, if that is the case.

Once you fully understand your Pennsylvania Medicare supplement insurance, you can avoid extra expenses and surprise bills.

How I Found The Right Pennsylvania Medicare Supplement Insurance

Monday, August 15th, 2011

When I needed Pennsylvania Medicare supplement insurance, it was time to panic. So many choices were offered at different premiums, I was confused and afraid to make a decision. I could not afford to buy the wrong policy. Finally, I found the right insurance agent to help me. This insurance agent said to write down my medical history, any special protections I might need and buy the best Pennsylvania Medigap insurance coverage I could afford. It was easy to find the right policy and feel good about the coverage when I followed her advice.

Medical History

It only took 20 minutes to write-down the medical history at first. Over the next two days, I added more information. By making a complete list of prescriptions, past medical history, present conditions and possible future events, important items, like expensive arthritis prescriptions or severe hay fever attacks in the spring, were not overlooked. Besides the normal doctor visits, tests and prescriptions, I have to be concerned with the aftermath of any hospitalization. As I live alone, any serious medical condition requires recuperating in a skilled nursing facility. After checking the Medicare coverage, I discovered Medicare only pays for 20 days and will pay anything over $124 a day from day 21 through day 100.

Probable Needs

I am young and fairly healthy. The only known major medical problem is a painful left knee. As my doctors have recommended a knee replacement, this procedure will be done sometime in the next few years. Therefore, the Pennsylvania Medicare supplemental insurance must cover rehabilitation care as I cannot go home without help or pay this expense myself. My blood pressure is under control, my heart is in good condition and my cholesterol level is low. Although I need to lose 20 pounds before surgery, I have no other known health issues.

Analyzing Different Policies

When I called the helpful insurance agent, she set an appointment and said we would only need 30 or 45 minutes if I brought the information. Once I showed the agent my list, the insurance agent asked a few questions and then reviewed different Pennsylvania Medigap plans. Although she included some economy priced packages, she clearly explained why they might not work. Among the best options were Pennsylvania Medicare part D coverage, which included rehabilitation and the two options under part F, the regular plan and the high deductible plan. The high deductible plan F pays nothing until I pay $1860 but it was less expensive. All of these covered foreign travel emergencies. After analyzing the different benefits and premiums, I chose the lowest cost policy meeting my requirements. The insurance agent cautioned me to purchase a policy I could easily afford, as the premium will probably rise in the future.

With the help of a knowledgeable agent, reviewing Pennsylvania Medicare supplement insurance plans was easy. By looking at health issues and anticipating future needs, I got the best policy. Pennsylvania Medicare supplement insurance takes the worry out of the future and allows me to get the medical treatment I need.

Why Buy Pennsylvania Medicare Supplement Insurance?

Saturday, July 30th, 2011

If you have Medicare as your primary health insurance and live in the state of Pennsylvania, have you thought about obtaining Pennsylvania Medicare supplement insurance?

Many times, individuals believe that Medicare will cover the full cost of their health care, and are surprised when they receive a bill for copayments or deductibles after a visit to the doctor.  Medicare coverage can be hard to understand, but when talking about coverage for things like physician visits and medical supplies, you should know that Medicare would only actually pay for 80% of allowed charges through their Part B benefit.  This means a physician’s visit costing $200 could cost you $40 out of pocket.

For those on a limited retirement income, $40 can be a lot of money.  Even individuals with larger incomes do not want to spend any more out of pocket than they have to, and that is where Pennsylvania Medicare supplemental insurance comes in.  For as low as a few dollars a week, these plans pick up any charges Medicare deems to be the responsibility of the patient.

Also known as Pennsylvania Medigap insurance coverage or Pennsylvania Medigap plans, a secondary policy of this type will always pay copay amounts after Medicare has processed a medical claim.  However, you should shop around for the best plan for the right price. 

Some Pennsylvania Medicare supplement insurance plans cover more than just the copay.  There are plans that will cover the $110 annual deductible and others that will pick up charges for items Medicare does not cover.  An example of this would be syringes used to administer insulin.  Medicare does not cover syringes, but a secondary insurance might pick up some or all of the cost.

Individuals worried about the cost of prescription medication may want to consider a Pennsylvania Medicare Part D coverage plan.  Unlike other plans, which offer medical benefits related to things like visits to a physician, medical supplies, and lab work, Part D coverage plans specifically address prescription medications. 

You should be very careful when looking into these plans, though.  Medicare Part D plans are some of the most complicated insurance plans available. Often there are large donut holes in the policies, which can cost you a great deal of money. 

A donut hole is a place in the annual medication expense where you pay 100% of the cost.  For example, a plan might pay 80% of drug costs up to $3,000.  Then, they might pick up 100% of the cost after $9,000.  Between those two amounts, you foot the bill. That means if you have over $9,000 of medication costs in a year, you will be paying for more than $6,000 of it!

When buying Pennsylvania Medicare supplement insurance of any type, always make sure you read the fine print in the policy.  Never buy insurance when you do not understand what you are paying for, what items will be covered, and understand how much the insurance will expect you to pay out of pocket. Supplement insurance can be a great friend to those with high medical costs, but the wrong insurance can cause unexpected expense.

Medicare Part D Coverage

Monday, June 14th, 2010

There are a number of different things for you to consider whenever you’re looking for Medicare part D coverage. Because this will cover any type of prescription medication, the benefits can really add up very quickly. Although you’re still going to be responsible for paying the monthly premium along with some expenses that may come out of pocket during the course of the year, it will quickly pay for itself whenever you regularly take prescription medications. Since everybody who has Medicare parts A or B is eligible for this prescription drug coverage, it helps if you understand the different plans that are available.

One of the first things that you should check is if it is necessary for you to get Medicare part D coverage at all. Some of the reasons why you would want to consider skipping this type of prescription drug coverage at this time is if you have additional insurance that may be covering it. For example, you may have Medicaid, which does cover prescription medication in many cases. You might also still have prescription medication that is available on your credit union or employee insurance account. Finally, you may be taking part in the Medicare advantage program that also offers prescription drug coverage. If that is the case, having Medicare part D coverage is not going to be necessary as it will be redundant.

The cost of the Medicare part D coverage is going to depend upon a number of different items as well. More than likely, you’re going to be responsible for a monthly premium to Medicare, along with an annual deductible and perhaps some co-pays as you fill your prescriptions. These can vary, depending upon your personal circumstances and the particular type of Medicare part D coverage that you happen to choose. You may also be able to get some additional help for Medicare, in which they will supplement or perhaps even subsidize these out-of-pocket expenses for you.

Finally, you should see what type of medications are covered underneath these various policies. At times, you may be taking a type of prescription medication that will require an additional co-pay or may not be covered at all. This can result in a considerable out-of-pocket expense. By choosing the right Medicare part D coverage from the start, you will be assured to have the insurance that you need for the medications that you take.

What is Medicare Part D Insurance?

Sunday, June 13th, 2010

It can be difficult to afford your prescription drugs, particularly whenever you do not have insurance. It may be possible for you to better afford your drugs on a regular basis whenever you qualify to take part in Medicare part D insurance. There is a little bit of confusion that surrounds this particular insurance plan, but in reality it is fairly simple to understand. Here is a little bit about Medicare part D insurance, and how you may be able to take advantage of this for yourself.

If you qualify for Medicare part A or part B, you also qualify for Medicare part D insurance. There are two different types of part D insurance that are available through Medicare. The first type is what is typically known as PDP or prescription drug plan. If you qualify for either part A or part B, you automatically qualify for PDP coverage. The other type of part D Medicare insurance is the Medicare advantage program, or MA program. This is a combination of both health insurance and prescription drug insurance. In order for you to qualify for the MA program, you must be taking part in both Medicare part A and B.

Regardless of which of these programs you are taking part in, it is a way for the United States government to subsidize some of your prescription drug costs. It was enacted in 2003, under the Medicare Prescription Drug, Improvement, and Modernization Act and it became available for those who are part of the Medicare program as of January 1, 2006. Since that time, thousands of individuals have been able to take advantage of Medicare part D in order to improve their financial circumstances and to be able to afford the prescription medications that they need. It is still open, and you may be able to take advantage of it yourself.

There are some limitations to Medicare part D that you should be aware of. For example, there may be an annual deductible that you will be responsible for, as well as a certain percentage that you will have to pay for any prescriptions that you receive. It is possible, however, that there are additional subsidies that are available to you which will cover these costs and either reduce them or get rid of them altogether. Speak to your insurance agent about Medicare part D in order to get more information on which of these programs you may be able to take advantage of.

Medicare Part D

Thursday, June 10th, 2010

Having Medicare part D can really help you to be able to afford your prescription drugs but it may still be difficult for some people to be able to afford them. This is not only because of the premium that you’re paying for Medicare part D, it is also because of the out-of-pocket expenses that are going to be accrued throughout the year. For example, most policies are going to have an annual deductible that needs to be met and you also have to pay such things as a co-pay or coinsurance each time you pick up your medication. Although there may be a limit to the amount of money that you spend, it can still add up over the course of time.

If you are having a difficult time affording your prescription medication, even when you have Medicare part D, you may be able to apply for additional assistance. The Social Security Administration is working along with Medicare in order to provide this assistance for individuals who are having financial difficulties. Considering the fact that most of us tend to accrue more costs with prescription medication as our income goes down, it really makes sense to have this help available.

Of course, you’re going to need to make sure that you qualify for this assistance before you apply. Much of the qualifying criteria includes the amount of money that you make on an annual basis. Additional things may also be taken into consideration, such as savings or additional insurance policies that you may have available. In most cases, you’re able to earmark some of the money that you have in savings for burial expenses.

There are also several different levels of help that may be available. Some of these will be able to help you with everything, from your out-of-pocket expenses of deductibles all the way up to the monthly premiums that you’re paying. Others will simply supplement some of the out-of-pocket expenses and make it easier for you to afford it.

Additional help may also be necessary from outside sources that will help to supplement the money that you’re paying for your prescription drugs. Some of these may be available in your local community while others are administered on a statewide basis. Look on the Internet for this information, as many of them are listed on various Medicare websites.

Medicare Part D Cost

Tuesday, June 8th, 2010

Medicare is an excellent federal program which helps individuals to be able to afford their medical expenses. As of 2006, it is possible for you to also get prescription drug coverage underneath your Medicare program. If you are enrolled in Medicare part A or B, you automatically qualify for Medicare part D, which is the prescription drug coverage. What many people are interested in, however, is what the Medicare part D cost is going to be. As with most things when insurance is involved, it is really going to depend upon what kind of coverage you have.

The major Medicare part D cost is going to come in the form of your monthly premium. This is going to vary, depending upon the type of coverage that you have. Along with that, you will also have additional expenses that are accrued throughout the year in the form of an annual deductible and co-pays that may also be included when you fill a prescription. This can amount to quite a bit of out-of-pocket expenses, and it can make it difficult for you to afford your prescriptions, even if you are covered underneath the drug policy.

Many people are able to supplement the Medicare part D cost in some way or another, but only if they qualify for assistance. You need to meet certain financial restrictions that will help you to qualify for this assistance, and it may reduce the amount of out-of-pocket expense that you have on an annual basis down to nothing. It can also lower your premiums, which can help you afford to pay for the insurance in the first place. If you think that you may qualify for this supplementary program, talk to Medicare in order to find out what the restrictions are.

One final thing that you should understand about the Medicare part D cost is that there is going to be a cap on the amount of money that you spend on an annual basis. This is known as catastrophic coverage, and it kicks in when you spend approximately $6500 for prescription medication annually. This figure is a combined figure of your co-pay and the amount that Medicare part D pays for your prescriptions. Once you hit this level, Medicare will begin paying for 95% of all of your prescription medications, which can really help you in such a financial crisis.

Medicare Part D Enrollment

Tuesday, June 8th, 2010

You would probably be surprised with the amount of Medicare part D enrollment options that you have available to you. As a matter of fact, it can get very confusing whenever you are trying to choose the policy that is going to work the best for you. If you break it down on a very basic level, however, it is often much easier to get to the point where you are able to compare these various policies, side by side. Here are some things for you to consider.

The Internet makes it very easy for you to take part in Medicare part D enrollment and to look at the various policies that you have available to you. As a matter of fact, there are websites that are available where you simply can view the plans in which you are interested in. With a simple click of a button, it will give you all of the information on a single page that will allow you to compare these policies so that you really understand what you’re going to be getting. More than likely, it will also give you links that will give you additional information on Medicare part D enrollment or those policies.

You need to consider that everybody who is 65 years of age or older is going to qualify for at least some form of Medicare part D enrollment. If you’re already taking part in Medicare part A or B, you automatically qualify for Medicare part D. If you’re taking part in the Medicare advantage program, you may have prescription drug coverage that is covered underneath that program. If that is the case, additional prescription drug coverage is not going to be necessary.

Another thing for you to consider whenever taking part in the Medicare part D enrollment plan is that you may have additional options that are available to you which will make it more affordable. These options are available for individuals that are having a difficult time paying for their prescription drugs, even when they are only paying the co-pay. If you meet the financial requirements, you may be able to get subsidized or have some type of supplementary insurance that is included with your Medicare part D plan. This will cover a lot of your out-of-pocket expenses and may actually reduce them down to nothing in some cases.

Medicare Part D Plans

Saturday, June 5th, 2010

In order to be able to afford your prescription medication, you may want to enroll in Medicare part D. The Medicare part D plans are available for individuals who are already enrolled in either Medicare part A or part B. If you are taking part in the Medicare advantage program and would like to also receive additional drug coverage, you must be enrolled in both parts A and B. It is interesting to note that not all Medicare part D plans are going to be the same and it may be necessary for you to look at these various plans in order to see which one is going to work best for you.

The easiest way for you to find out what is available in the Medicare part D plans is to look at the Internet on the Medicare part D comparison website. You will need to fill out a form with certain information that will help you to find the plans that will work the best for you. Some of the information that they will need is the state in which you reside, whether or not you also have Medigap insurance, the maximum deductible and maximum premium. You can then sort the results from lowest to highest or according to a number of different credentials. At a glance, this will allow you to see the various Medicare part D plans that are available so that you can choose one easily.

Another tool that is available to help you compare between the Medicare part D plans gives you additional options that are not available in the standard search. These will also ask you basic questions, such as the state in which you live and the maximum deductible and premium. You will also be able to provide additional information, such as the type of drugs that are going to be taken on a regular basis, along with whether you are subsidized in any way for your Medicare payments.

Even though these two websites make it very easy for you to be able to compare Medicare part D plans, it may still be of benefit to you to speak to an insurance agent or perhaps to Medicare in order to sort things out. Remember, prescription drugs are very expensive and you need to make sure that you have the right type of insurance coverage in order to be able to afford them regularly.

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