Several items you should know about Part D:
- Buying a Prescription Drug Plan (PDP) with the lowest premium isn’t always the wisest choice. It really boils down to the prescription drugs you take and the overall estimated combined total annual costs including not just the PDP premium, but all out of pocket expenses such as: the copays, coinsurance, donut hole costs, and the RX deductible. Also less expensive plans may not cover as many drugs in the plan formulary.
- A formulary is a list of ALL the drugs covered in a prescription drug plan. If it is not listed in the plan formulary, it is NOT covered!
- Make sure the Prescription Drug Plan you choose includes all your drugs in the plan's formulary. Also be sure to check the tier level and cost of each of your drugs before enrolling.
- Most Medicare Prescription Drug Plans have at least 4 tier levels, but some plans may have as many as 5 or more tier levels. Generally the lower the tier level, the lower the expense of the drug, and the lower its copay that goes with it. For example, tier 1 drugs are generally the least expensive preferred generic drugs, and the costs and out of pocket expenses increase, as the tier level increases. The same exact drug can vary tier levels from one plan to another plan! So it is important to check the tier level of each drug for each plan you compare. Don’t assume the tier level for a drug is going to be the same tier level in a different plan.
Not all prescription drug plans are the same, but a typical example of a plan's tier levels could be:- Tier 1 Preferred Generic
- Tier 2 Generic
- Tier 3 Preferred Brand
- Tier 4 Non-Preferred Drug
- Tier 5 Specialty Drug
- A new Tier may also be shown: (Select Insulin Drugs)
- You can only enroll in a Prescription Drug Plan during certain periods of the year, unless you qualify for a Special Election Period. (SEP). The main time to enroll is Annual Election Period (AEP), which is from 10/15 through 12/7. That is when everybody that qualifies for Medicare Prescription Drug Plans are allowed to enroll in a plan or even people with existing plans are also allowed to switch to a new plan with an effective date of 1/01 of the next year.
- You can compare your specific estimated out of pocket drug costs, including plan premiums on Medicare.gov. You would just plug in all your specific drugs, dosages, quantities (how many you take per month), your favorite preferred pharmacies, and then Medicare.gov will shop around for you to show which drug plan is estimated to be the least expensive annually for you overall.
- You need to educate yourself on the "Coverage Gap” (Also known as the "Donut Hole.”) Due to Medicare regulations, all Prescription Drug Plans will have these different drug payment stages after the Drug Deductible Stage (if applicable): 1) Initial Coverage Stage, 2) Coverage Gap Stage 3) Catastrophic Coverage Stage.
- Important note to keep in mind: If you don’t enroll in a Prescription Drug Plan (Part D) when you are first eligible and you need to enroll in one later in life, you will be penalized by the government 1% per month for every month you missed, since you were first eligible, for as long as you have a Medicare Prescription Drug Plan! So even if you don’t take any drugs, I would suggest you enroll in an inexpensive Medicare Prescription Drug Plan when you are first eligible.
Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.
By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.
By calling this number, I understand I will be directed to a licensed insurance sales agent.