Archive for the ‘medicare part d coverage’ Category

Medicare Part D – Policy costs and the donut hole

Friday, February 10th, 2012

To continue with our discussion of Medicare Part D prescription drug coverage, this article will discuss the costs of Part D and the coverage gap, also called the “donut hole.”

Policy costs


There are many factors that will influence the cost of your Part D coverage. They will vary depending on the types of drugs you use and whether or not your plan covers them. The type of plan you choose is another variable, as is the pharmacy you use and whether or not it is part of a network. There will be a monthly premium that you pay, in addition to the premium that you pay for your Medicare Part B. If you belong to a Medicare Advantage plan that includes prescription drug coverage, then your prescription drug plan costs will be added to the plan’s monthly premium.

Deductibles and copayments:

Most prescription drug policies require the insured to pay an annual deductible of up to $310. After you have paid the deductible, you are then required to pay a copayment on your prescriptions until the combined amount paid by you and the insurance plan comes to $2840. Once you have reached a total of $2840, you are then in what is called the coverage gap, or the donut hole. This is a temporary limit on what the drug plan will cover for your prescription drugs.

Coverage gap or donut hole

As stated previously, you enter the coverage gap or donut hole once you and your insurance company together have spent over $2840 in one calendar year. Once you are in the donut hole, you are then responsible for the total cost of your prescription drugs until your drug coverage kicks in again. In 2011, covered individuals paid 50% of the cost of name-brand prescription drugs and 93% of the cost of generic drugs while in the coverage gap. These costs will drop in subsequent years until by 2020 participants will be paying no more that 25% of the cost of their prescriptions while in the gap.

You are able to get out of the gap when the total amount spent reaches $4550 (in 2011). This includes the pre-gap payments of $2840, plus $1710 paid on prescription drugs while in the gap. When calculating the $1710 spent while in the gap, the actual cost of the name-brand drugs is counted toward the total, not just the 50% discount. Once an individual has reached the $4550 limit, then catastrophic drug coverage kicks in.

Catastrophic drug coverage

With catastrophic drug coverage, the prescription drug plan will cover 95% of the remaining drug costs for the rest of the calendar year. Then it begins all over again.

Some Part D plans do offer additional gap coverage that will cover generic drugs while in the gap, but these plans will have a higher monthly premium. Qualified individuals can also apply for Extra Help. This is a program for people with limited income and resources provided by Medicare and Social Security. You would apply for Extra Help at your local Social Security office.


Sources used in this article:


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

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.

What You Should Know When You Are Buying Pennsylvania Medicare Supplement Insurance

Monday, July 25th, 2011

When started researching Pennsylvania Medicare supplement insurance, I was overwhelmed by all of insurance plans provided by various health insurance providers.  If you are approaching retirement, I strongly recommend you start comparing Pennsylvania Medigap plans early.  When you do your homework, you can make an informed decision and get peace of mind in knowing you have the right supplemental coverage.  If you fail to do your homework as I did, you may end up investing in less than adequate Pennsylvania Medigap insurance coverage.  Do not assume you are fully covered by Medicare and understand how Pennsylvania Medicare supplement insurance plans will cover all of your medical needs.


Do Not Be Fooled, All Gap Insurance Plans are Regulated By the Federal Government


Health insurance companies will pressure you to buy the most expensive Pennsylvania Medicare supplemental insurance plan.  Sales agents pressure you with scare tactics of what may happen to your home, your family, and your life, if you buy the wrong supplement plan.  When I first signed up for my Pennsylvania Medicare supplement insurance, the insurance agent I dealt with successfully pressured me into purchase the most expensive plan available.  This plan is referred to as Medigap Plan N.  In order to qualify for Medigap N, purchasing Medigap A and B was a requirement.  I also had to invest in Pennsylvania Medicare Part D coverage separately if I wanted any coverage for prescription drugs.  After I ended up selecting all of the plans I needed, I quickly realized I was spending a small fortune on my supplemental Medicare insurance.


This is when I started researching what plans are best.  Yes, I admit, I should have done my homework before I signed up for my plan.  However, doing my homework later was certainly better than paying without a second thought.  When I started to doing my research, I discovered that the Federal Government regulates all gap plans.  While not all insurance companies offer all 12 gap plans, each company that does must offer the same benefits.  This enticed me to contact another insurance agent with the reputation of informing their clients and not pressuring them.


An Honest Insurance Agent Will Sell You the Right Pennsylvania Medicare Supplement Insurance


Evaluating what policies meets your needs and your budget, is the most important thing you can do.  Make sure to locate insurance agents in your area that are experienced in Medigap insurance.  When I sat down with my city’s most prided insurance agent, I found out that the plan I invested in gave me great benefits at a cost.  I informed my agent of my budget and my budget worked up a comparison chart to show my how much I could get for my money. 


The process of switching Medicare supplement insurance plans can be frustrating.  Sit down with an agent who will recommend the best policy to suit your needs.  When you invest in insurance, agents should think about your needs and not their commissions.  Customize your Pennsylvania Medicare supplement insurance make careful considerations before you choose one.

Why I Decided To Supplement My Medicare Coverage

Monday, July 18th, 2011

I recently had my sixty-fifth birthday and enrolled in Medicare, but I realized that it would not pay for all of my medical bills so I also started looking for Pennsylvania Medicare supplement insurance. I wanted coverage that would take care of me the way that I wanted to be taken care of. It simply seemed that there were too many doctors in my town who did not accept Medicare. Not even my long-time trusted family doctor accepted that sort of coverage. I asked his office manager what she would advise, and she told me to look at some Pennsylvania Medicare supplement insurance plans. A good plan, she explained, would allow me to keep visiting their office with little to no out of pocket expenses.


In addition to worrying about which doctor I got to visit, I also had other issues weighing heavily on my mind. I had read in a recent New York Times editorial that Medicare was running out of money. The columnist claimed that it was responsible for spending billions of dollars each year on the elderly and the chronically ill. I knew that there was no way that Medicare could keep up with these payments so I looked at Pennsylvania Medicare supplement insurance plans to give me additional peace of mind. However, once I started researching my options, I learned several things about Pennsylvania Medicare supplemental insurance.


I learned that Pennsylvania Medigap insurance coverage was heavily regulated by the state and federal governments. It did not offer what I had expected from a private insurer, but it offered a lot of benefits that I decided would be worthwhile. It would help me quite a bit now that my income was a little lower. Most Pennsylvania Medigap plans would cost the same amount of money regardless of my age. These plans would not allow me to see whichever doctor I wanted to, but they would help me in other ways. This coverage would pay for the co-pays that Medicare did not cover. It would not pay for long term care in the nursing home or hospital, but it would help me financially along the way. However, these plans did not seem to offer anything to help pay for the prescription drugs that I needed. I did not want to take hundreds of pills a day, but I needed a couple of prescriptions. For instance, I was on a small steroid to help with my arthritis. Without that drug, I would be in pain for most of the day.


Then, I found Pennsylvania Medicare part d coverage. This coverage would help pay for the cost of my prescription drugs. Depending upon which drug I was buying, it would offset anywhere from thirty to fifty percent of my out of pocket costs. I was more comfortable saving that money than spending it, and I really liked the flexibility that I got when I opted to add this additional coverage to my current government insurance plan. All of the research that I did on Pennsylvania Medicare supplement insurance helped me to realize where the holes in the Medicare coverage are, and I realized how helpful it is to add additional policies.

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.

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.

Get a Quote: 1-800-392-5621
Site by: | Template by: WP-Spider