Medicare

Part D Rx Prescriptions

Part D Rx is practically mandatory.  If you don’t have coverage when you are supposed to your premium is increased  12%/year when you eventually do.

Many Part D  plans cover the gap or donut hole, just be sure to read the illustrations, brochures, Medicare Guide to Rx  and drug formularies, on or through our website.

Medicare Advantage plans generally include prescription drug coverage, including both brand-name and generic at participating pharmacies in your area.

Check out our  webpages for more details, coverage and premiums.

The Annual Open Enrollment (AEP) is from October 15th to December 7 and then your coverage will begin January 1 (Medicare FAQ.)

If you’ve just turned 65, you’re eligible now!email us or review this website for details.

If you have a Medicare Advantage Plan, with or without Rx coverage and you sign up for Part D coverage, you WILL be dropped from the Medicare Advantage plan! cahealthadvocates.org

You may sign up right through our site, for Part D Rx, see the links on the respective pages,  Medicare Advantage Plan or a Medi-Gap – Supplement Plan.

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Medicare Part D Shopping Video

How to shop Part D rx plans

Learn more on our webpage about the Shopping Tool along with Q & A or Ask your own question at the bottom of the Q & A section

BE CAREFUL OF THE SNAFU'S!!!

The “Total Yearly Cost of Care” does not provide personalized or transparent information. For example, when a consumer inputs or changes personal data, such as drug information, his or her total estimated costs do not change. This is not mathematically possible based on the plan benefits. Additionally, the tool does not share what is included in the total cost. As a result consumers will likely see the total cost and assume they are receiving a personalized and tailored estimate which may not be accurate.

The estimated total yearly cost of care is flawed. On a plan that has reduced benefits year over year, the expectation would be that the “estimated total yearly costs” would increase. However the tool is inaccurately estimating the consumer’s costs will decrease. It doesn’t make mathematical sense. For consumers on a fixed income and cost conscious, this could be detrimental to their situation.

Most supplemental benefits are not included in the total yearly cost of care. Over the past several years supplemental benefits have expanded and provided members with options that not only treat, but prevent illness and increase quality of life. We know the high value of benefits such as vision, dental and hearing to our consumers, and they are a key way we are partners in care with our members. Some of the benefits that are not included are:

Transportation lists copay but not number of rides.

Eyeglasses list copay but does not share if benefit covers frames, lenses or contacts.

Wellness Programs include a long list of possible items including fitness, nurse hotline, Personal Emergency Response and telehealth, that can’t be lumped into a single “covered” or “not covered” benefit.  Excerpt from UHC Agent Memo  * Forbes GAO 7.2019 Report

Research & Technical Resources

medicare.gov/part-d/

Medicare Prescription Drug, Improvement and Modernization Act of 2003 416 Page pdf gpo.gov

Wikepedia

2017 Announcements 250 pages

 

Part D—Voluntary Prescription Drug Benefit Program

Subpart 1—Part D Eligible Individuals and Prescription Drug Benefits

Sec. 1860D-1. Eligibility, enrollment, and information

Sec. 1860D-2. Prescription drug benefits

Sec. 1860D-3. Access to a choice of qualified prescription drug coverage

Sec. 1860D-4. Beneficiary protections for qualified prescription drug coverage

Subpart 2—Prescription Drug Plans; PDP Sponsors; Financing

Sec. 1860D-11. PDP regions; submission of bids; plan approval

Sec. 1860D-12. Requirements for and contracts with prescription drug plan (PDP) sponsors

Sec. 1860D-13. Premiums; late enrollment penalty

Sec. 1860D-14. Premium and cost-sharing subsidies for low-income individuals

Sec. 1860D-14A. Medicare coverage gap discount program

Sec. 1860D-15. Subsidies for Part D eligible individuals for qualified prescription drug coverage

Sec. 1860D-16. Medicare prescription drug account in the federal supplementary medical insurance trust fund

Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans

Sec. 1860D-21. Application to medicare advantage program and related managed care programs

Sec. 1860D-22. Special rules for employer-sponsored programs

Sec. 1860D-23. State pharmaceutical assistance programs

Sec. 1860D-24. Coordination requirements for plans providing prescription drug coverage

 

 

Prescription Drug Coverage – General Information

 
The MMA legislation provides seniors and people with disabilities with the first comprehensive prescription drug benefit ever offered under the Medicare program, the most significant improvement to senior health care in nearly 40 years.This overview page provides links to important information on the new benefit.

Click the selection that best matches your area of interest.  Please check back, as we will continue to update these resources regularly.

 

10 comments on “Part D Rx Prescriptions

  1. Is there a table or listing of each company’s Part D premiums, copays, deductibles I can look at for comparison?

    • You can pay your premium by:

      ■■Signing up to have your plan deduct it from your checking or savings account.
      ■■Charging it to a credit or debit card.
      ■■Having your plan bill you each month directly. Some plans bill in advance for next month’s coverage. Send your payment to the plan—not to Medicare. Contact your plan for their payment address.
      ■■Having funds withheld from your Social Security payment.

      Contact your plan—not Social Security—to ask for this payment option. It may take up to 3 months to start, and it’s likely the first 3 months of premiums will be collected at one time. Publication 11109 Guide to Part D

  2. I know that if I get a Medi Gap plan, I can buy Part D Rx and that if I get a Medicare Advantage with Part D MA-PD I can’t get extra coverage to cover Rx, what are the other restrictions on what plans go with Part D and which ones don’t?

    • Yeah, it’s a confusing question as so much of the questions and plans do not apply to California, but yet when we do our AHIP annual certification, they ask a ton of questions on it. IMHO especially annoying is the AHIP material doesn’t give citations and isn’t “official” plus it’s copyrighted… and password protected. I wish they training just used Official brochures that we could use with the public.

      Here’s the Q & A from an official brochure on Part D Rx This is the 2018 revision, so beyond 2020 the page #’s might be different.

      Section 4: Your Coverage Choices

      Get help with drug coverage decisions (of course you can email us [email protected] or leave your question below too) What else do I need to think about before I decide to get Medicare drug coverage?

      I have only Part A and/or Part B and no drug coverage I have Medicare and a Medicare Supplement Insurance (Medigap) policy without drug coverage
      ” Medicare Supplement Insurance (Medigap) policy with drug coverage
      ” get drug coverage from a current or former employer or union
      ” Federal Employee Health Benefits (FEHB) plan
      ” TRICARE or benefits from the Department of Veterans Affairs (VA) that include drug coverage I have a Medicare health plan (MA Medicare Advantage) without drug coverage
      I have a Medicare health plan with drug coverage MA PDI have Medicare and Medicaid Medi-Cal
      … get Supplemental Security Income (SSI) benefits or belong to a Medicare Savings Program
      … and live in a nursing home or other institution
      … and benefits through Programs of All-inclusive Care for the Elderly (PACE)
      … and get help from my State Pharmacy Assistance Program (SPAP) paying drug costs
      I get help from an AIDS Drug Assistance Program (ADAP)
      I have Medicare and get drug coverage from the Indian Health Service, Tribe or Tribal Health Organization, or UrbanIndian Health Program

      Official Medicare Brochure # 11109 Prescriptions

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