Medicare Part D
Medicare Part D, also known as Prescription Drug Plan, changes every year. As we discussed last month, Annual Enrollment Period (AEP) occurs once a year. This is the only time of the year you can change your Part D plan unless you qualify for a Special Enrollment Period (SEP). For example, if you move out of the service area, if you are institutionalized, or experience any other “exceptional circumstance,” you may be qualified for a SEP.
There are different phases to Part D coverage, and we know it can get confusing, especially with phrases like ‘donut hole’. Let’s talk about the four stages of Part D coverage below:
- Deductible Stage – During this stage you will pay the full cost of your medications until the deductible is met. The average deductible is around $415.
- Initial Coverage Stage – After you meet your deductible, your plan will help pay for your medications. Your plan will pay for some of the cost, and you will pay a copay or coinsurance until you reach your plan’s initial coverage limit. How long you stay in this stage depends on your drug costs and your plan’s benefit structure.
- Coverage Gap – This stage, commonly known as the “donut hole,” the client will pay approximately 25% for brand-name medications and 25% for generic medications.
- Catastrophic Stage – After you reach a total of $5,000 in out-of-pocket expenses you will enter this stage. During this stage you will pay the greater of 5% coinsurance for generic medications and the greater of 5% for brand-name medications.
MWG Senior Services offers the free service of assisting our Medicare Supplement and Medicare Advantage clients with their Part D drug analyses each year. If you would like to review Medicare Supplement or Medicare Advantage plan options, please give us a call today at 877-759-5760 or email us at firstname.lastname@example.org. Let us know that you read this blog!