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Here we will go over how Prescription coverage works with Medicare and Medicare Advantage.
Medicare prescription drug coverage is an optional benefit. Medicare drug coverage is offered to everyone with Medicare. Even if you don’t use prescription drugs now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare prescription drug coverage. To get Medicare prescription drug coverage, you must join a plan approved by Medicare that offers Medicare drug coverage. Each plan can vary in cost and specific drugs covered. Visit Medicare.gov/plan-compare for more information about plans in your area
1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A and/or Part B to join a Medicare Prescription Drug Plan.
2. Medicare Advantage Plans or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.
In either case, you must live in the service area of the Medicare drug plan you want to join.
Call your benefits administrator before you make any changes, or sign up for any other coverage. Signing up for other coverage could cause you to lose your employer or union health and drug coverage for you and your dependents. If you lose your employer or union coverage, you may not be able to get it back. If you want to know how Medicare prescription drug coverage works with other drug coverage you may have
• When you first become eligible for Medicare, you can join during your Initial Enrollment Period.
• If you get Part A and Part B for the first time during the General Enrollment Period, you can also join a Medicare drug plan from April 1– June 30. Your coverage will start on July 1.
• You can join, switch, or drop a Medicare drug plan between October 15– December 7 each year. Your changes will take effect on January 1 of the following year, as long as the plan gets your request before December 7. • If you’re enrolled in a Medicare Advantage Plan, you can join, switch, or drop a plan during the Medicare Advantage Open Enrollment Period, between January 1–March 31 each year.
• If you qualify for a Special Enrollment Period.
Special Enrollment Periods are times when you can join, switch, or drop your Medicare drug coverage if you meet certain requirements. Generally you must stay enrolled in your Medicare drug plan for the entire year, but you may be able to change your coverage mid-year if you qualify for a Special Enrollment Period when certain events happen in your life. Check with your plan for more information.
You can switch to a new Medicare drug plan simply by joining another drug plan during one of the times listed above. You don’t need to cancel your old Medicare drug plan. Your old Medicare drug plan coverage will end when your new drug plan coverage begins. You should get a letter from your new Medicare drug plan telling you when your coverage with the new plan begins. You can switch plans by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048
If you want to drop your Medicare drug plan and don’t want to join a new plan, you can only do so during certain times. See page 74. You can disenroll by calling 1-800-MEDICARE. You can also send a letter to the plan to tell them you want to disenroll. If you drop your plan and want to join another Medicare drug plan later, you have to wait for an enrollment period. You may have to pay a late enrollment penalty if you don’t have creditable prescription drug coverage.
Review the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) your plan sends you each year. The EOC gives you details about what the plan covers, how much you pay, and more. The ANOC includes any changes in coverage, costs, provider networks, service area, and more that will be effective in January. If you don’t get these important documents in early fall, contact your plan.
In this Stage you pay for your drugs until you reach the deductible amount set by your plan. Not every plan will have a Deductible. If your plan does not have a deductible your coverage starts with the first prescription you fill. at the end of this stage you enter Initial Coverage.
You Pay a copay or coinsurance and the plan pays the rest. You stay in this stage until your total Drug costs in 2020 Reach $4020. Total Drug cost includes Your out of pocket, what the plan pays, and any discounts from the drug companies. When this is reached you enter the Coverage gap.
In 2020 you pay 25% of the cost for brand name drugs and 25% of the cost for generic Drugs. You stay in this stage until your out of pocket total reaches $6,350 in 2020.
If you Reach $6,350 you will enter the Catastrophic Stage and pay a small copay or coinsurance for the rest of the plan year.