Medicare Prescription Drug Coverage
If you’re covered by Medicare, here’s some welcome news – Medicare drug coverage can help you handle the rising cost of prescriptions. If you’re covered by original Medicare, you can sign up for a drug plan offered in your area by a private company or insurer that has been approved by Medicare. Many Medicare Advantage plans will also offer prescription drug coverage in addition to the comprehensive health coverage they already offer.
Although prescription drug plans vary, all provide a standard amount of coverage set by Medicare. Every plan offers a broad choice of brand name and generic drugs at local pharmacies or through the mail. However, some plans cover more drugs or offer a wider selection of pharmacies (for a higher premium) than others, so you’ll want to choose the plan that best meets your needs and budget. HOW MUCH WILL IT COST? What you’ll pay for Medicare drug coverage depends on which plan you choose. But here’s a look at how the cost of Medicare drug coverage for a standard plan is generally structured. All figures are for 2016.
YOU SHOULD COMPARE THE DETAILS OF EACH PLAN AVAILABLE IN YOUR AREA BEFORE CHOOSING ONE. YOU CAN GET PERSONALIZED PLAN INFORMATION AT THE MEDICARE WEBSITE, WWW.MEDICARE.GOV, OR BY CALLING A MEDICARE COUNSELOR AT 1-800-MEDICARE.
A monthly premium: Most plans charge a monthly premium. Premiums vary, but average $32.50. (Source: Centers for Medicare & Medicaid Services.) This is in addition to the premium you pay for Medicare Part B. You can have the premium deducted from your Social Security check, or you can pay your Medicare drug plan company directly. An annual deductible: Plans may require you to satisfy an annual deductible of up to $360. Deductibles vary widely, so make sure you compare deductibles when choosing a plan. A share of your prescription costs: Once you’ve satisfied the annual deductible, if any, you’ll generally need to pay 25% of your prescription costs and your Medicare drug plan will pay 75% of your costs until they total $3,310. After that, there’s a coverage gap (also called the “donut hole”); you’ll need to pay 100% of your prescription costs while you’re in the donut hole. (Some plans offer coverage for this gap.) However, once your prescription costs for the year total $7,062.50, your Medicare drug plan will generally cover 95% of any further prescription costs. For the rest of the year, you’ll pay either a coinsurance amount (e.g., 5% of the prescription cost) or a small co-payment for each prescription, whichever is greater. Note: In 2016, if you have spending in the coverage gap, you’ll receive a 55% discount on covered brand-name drugs, and a 42% discount on covered generic drugs. Again, keep in mind that all figures are for 2016 only – costs and limits may change each year, and vary among plans. WHAT IF YOU CAN’T AFFORD COVERAGE? Extra help with Medicare drug plan costs is available to people who have limited income and resources. Medicare will pay all or most of the drug plan costs of seniors who qualify for help. If you haven’t already received an application for help, you can get one at your local pharmacy or order one from Medicare. WHEN CAN YOU JOIN? Individuals new to Medicare have seven months to enroll in a drug plan (three months before, the month of, and three months after becoming eligible for Medicare). Current Medicare beneficiaries can generally enroll in a drug plan or change drug plans
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