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Medicare Part D Prescription Drug Plan

Medicare Part D prescription plans began in January of 2006 after the federal government passed the Medicare Prescription Drug, Improvement, and Modernization Act. This law was passed to give Medicare beneficiaries and disabled citizens access to drug coverage. These plans are available through most Medicare Advantage plans. Also they can be purchased as a stand- alone drug plan. These can be combined with Original Medicare, a Medicare Supplement, or with certain types of advantage plans. Coverage with these plans begin January 1st and end December 31st of every year. This allows an individual to shop their plan on an annual basis. We recommend taking time at the end of every year to review the benefits or any changes made to the current plan for next year. Below are a few quick facts. Keep in mind, most of these numbers and benefits change or reset at the beginning of every year.

 

1. There are 28 drug plans available in Georgia that are offered by 10 companies.

2. The lowest monthly premium is $13.20 and the highest is $84.20.

3. Beneficiaries with Medicare who have limited income and assets may qualify for Extra Help with the costs of their prescription drugs. This program is also known as LIS, or the Part D Low Income Subsidy. This can help pay for Part D expenses, including monthly premium, annual deductible, coinsurance, and copayments. There are four different levels of LIS. The amount of LIS a beneficiary receives depends on their income and assets.

4. There is no underwriting, therefore any Medicare beneficiary can sign up for a PDP plan.

5. Medicare PDP plans have formularies that must cover at least 2 drugs in every therapeutic category.

6. Vitamins and non-prescription medication are not covered under Part D.

7. A beneficiary can purchase a drug plan or change an existing plan during the Annual Enrollment Period which is between October 15th and December 7th of each year.

8. There are typically 5 Tiers, or coverage levels within each drug plan. Co-pays vary in each tier. With all plans though, the lower the tier, the lower the cost. Some Tier 1 medications are $0.

9. Some recipients will pay a higher premium cost for their plan. This is based on income levels.

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