Until 2006, Medicare beneficiaries had no prescription drug coverage. Medicare Part D was introduced in 2006, providing millions of beneficiaries with much-needed prescription drug coverage. Although Medicare Part A and Part B cover prescription meds in certain circumstances, Part D is the primary source of prescription drug coverage for Medicare beneficiaries
Medicare Part D requirements
Medicare Part A and Part B are administered by the federal government. Medicare Part D, however, is provided by private insurance carriers. Most people have access to 20 or more different Part D plans.
Although Part D plans vary, there are specific requirements they must meet. For example, Medicare sets a maximum allowable Part D deductible each year; plans can charge a lower deductible, but it can’t exceed the maximum deductible. Another requirement involves the types of drugs all Part D plans must cover.
Medicare requires every Part D plan to cover at least two drugs from each drug class. Additionally, many Part D plans cover nearly all medications in these six drug classes: antidepressants, anticonvulsants, antipsychotics, immunosuppressants, anti-cancer, and HIV/AIDS medications.
Medicare does not, however, require Part D plans to cover any drugs used to treat any of the following:
- Benzodiazepines – usually prescribed for anxiety and/or insomnia
- Cold symptoms
- Erectile dysfunction
- Hair loss
- Weight loss/gain
Medicare Part D plans are also not required to cover sedatives or compounded medications. With that said, Medicare Part D plans may cover the types of medications mentioned above, but they aren’t required to.
Medicare Part D payment stages
Medicare also regulates the coverage limits of each payment stage under Part D plans. Part D plans all have four payment stages: deductible, initial coverage, coverage gap, and catastrophic coverage. As discussed above, the deductible cannot be any higher than the maximum set by Medicare, which as of 2021, is $445.
Once you have paid the deductible, you will move into stage two: initial coverage. During this stage, you will pay a copay or coinsurance determined by the plan carrier. The copays and coinsurance vary by drug tier. For example, you might pay a $10 copay for a tier one drug but a 25% coinsurance for a tier three drug.
After you and your plan have spent a specific amount of covered drugs for the calendar year, you will move into stage three: coverage gap. While in the coverage gap, you will pay a 25% coinsurance for all covered drugs.
Once you and your plan have spent a certain amount for the year, you will move into stage four: catastrophic coverage. During this stage, you will pay around 5% for your medications. Only about 10% of Part D beneficiaries reach stages three or four.
Finding the most cost-effective Part D plan
There are specific enrollment periods for Part D. The first time you may enroll in a Part D plan is during your Initial Enrollment Period (IEP). You can then change Part D plans once a year during the Annual Election Period (AEP).
To find the most cost-effective Part D plan, you should create a MyMedicare account and enter every prescription drug you take. Your account will save this list of medications for you, so each year when you shop for Part D plans, you can simply update the list instead of re-adding all your medications. Once you have created your account, you will use Medicare’s Plan Finder Tool to compare all the Part D plans in your ZIP code.
The Medicare Plan Finder Tool is a robust tool that allows you to review each plan’s covered drugs, preferred pharmacies, drug costs, and much more. Since Part D plans can change from year to year, checking this tool each year ensures that you are always enrolled in the most cost-effective plan.
How can I make the most of my business trip in Jeonju with rejuvenating massage experiences?
Jeonju, a city famous for its rich social heritage and scrumptious cuisine, offers something other than a thriving business environment. For business explorers, incorporating rejuvenating massage experiences into your itinerary can hoist your visit and provide an ideal harmony among work and relaxation. This is…
Use the world-class telemedicine and Tele counseling services on time
Have you understood the significance of improving your overall health without compromising the schedule and budget? You can explore and make certain the basics of the telemedicine and telecounseling services at this time. Telemedicine is real-time and remote medical services. It lets patients get…