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Prescription drug coverage known as "Part D" is
available to anyone who is enrolled in Medicare Part A & Part B. These plans are offered
by private insurers that charge a premium and are sometimes included in
Advantage Plans that may or may not
charge a premium. The cost of the plans, copayments, deductibles (if
any) and the drugs covered vary from
company to company.
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2010 Member Expense
for Part D Plans:
Who Pays What? |
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Premium* |
Deductibles* |
Copayment or Coinsurance* |
Coverage
Gap** |
Catastrophic Coverage |
|
Member |
Member pays a monthly amount |
From $0 to $310 depending on plan. |
Member pays copayments or coinsurance until Plan payments
plus member payments, including deductible, reaches $2,830. |
Once member and Plan have spent $2,830 for covered drugs, the
member enters the "coverage gap". Member will have to pay all
drug costs until they have spent $4,550. |
Once member has spent $4,550 out-of-pocket for the year, the
coverage gap ends. Now member only pays a small copayment or
coinsurance for each drug until the end of year. |
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|
|
Copay or coinsurance + deductible (if any) + Plan = $2,830 |
Up to $4,550 in true out-of-pocket costs = member*** |
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|
Plan |
|
Plan pays its share after deductible has been paid by member |
Plan pays its share until Plan plus member amount paid
reaches $2,830 |
Plan pays nothing. Any cost paid by the plan since January 1
are not applied toward the member's true out-of-pocket costs
during the coverage gap. |
Plan pays the remainder of the costs after the member pays
their share. |
*Deductibles, premiums and copay / coinsurance vary by plan.
**Some plans will cover some medications during the coverage gap.
*** True out-of-pocket cost = Deductible (if any) + copayments /
coinsurance + discounted price of drugs during gap
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Prescription Drug Coverage Plan Changes for
2010 |
| |
2010 |
2009 |
| Annual Deductible |
If applicable $310 |
If applicable $295 |
| Initial Coverage Stage |
Ends at $2,830 |
Ends at $2,700 |
| Coverage Gap |
Until $4,550 |
Until $4,350 |
Enrollment in Medicare drug plans are guaranteed acceptance and the
plans can not turn you down for preexisting conditions. Premiums are not
determined by health conditions, age or gender. You can enroll,
drop, or change plans at these times:
- 3 months before or after you first become eligible for Medicare
- Every year from November 15 - December 31 for an effective date
of January 1st of the following year
- You move out of the servicing area
- Your plan looses their contract with Medicare
- At anytime you qualify for extra help
- You enter or leave a nursing home
With over 50 plans available in most areas choosing the right plan
can be confusing. We have a method of finding the exact plan that fits
your individual needs. |
