Medicare Part D
Medicare is a health insurance program administered by the Federal Government, providing health insurance coverage to people who are 65 years of age or older, under age 65 with certain disabilities and at any age with End-Stage Renal Disease (ESRD – permanent kidney failure requiring dialysis or a kidney transplant).
MEDICARE Part D (Prescription Drug Coverage)
Medicare Prescription Drug Plans are stand-alone drug plans that add prescription drug coverage to Original Medicare. Prescription Drug Plans assist with the cost of prescription drugs, vaccines, and some medical supplies not covered by Medicare Part A and Part B.
Part D was designed to aid people with Medicare, lower their prescription drug costs and to protect against future costs. This prescription drug plan will allow you to have access to medically necessary drugs. Except for certain situations, you should enroll in Part D when you first become eligible to avoid penalties.
Keep in mind all Part D plans have different phases. In the “initial phase,” you will pay a certain co-pay/co-insurance after you meet the deductible. When you reach the “coverage gap” this means that you and your plan together have spent a certain amount of money for covered drugs; at this point, your cost-sharing will increase to 25% of the cost of the negotiated retail cost of the medication until you reach “Catastrophic Coverage”. When and if you reach “Catastrophic Coverage” you will then pay 5% of the negotiated retail price for the rest of the plan year.
Your yearly deductible, your coinsurance or copayments, and what you pay in the coverage gap all count towards this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
Provide your Prescription Drug Plan Card and a Photo ID. If you are eligible for both Medicare & Medicaid, you will want to provide proof of your enrollment in Medicaid as well.
If you need to go to the pharmacy before your membership card arrives, you can use any of these as proof of membership:
- The acknowledgement, confirmation, or welcome letter you got from the plan.
- Print a temporary card from your Part D plans website.
- Call our office at 509-735-1011 so that we can assist you in getting the information needed to get your medications.
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