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Your Source for Medicare Part D Information
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What are Medicare Part D Prescription Drug Plans and Medicare Advantage Plans?
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New to the Medicare Part D and Medicare Advantage plan program? Looking for a place to get started? Here is an overview of the Medicare Part D prescription drug and Medicare Advantage programs: Medicare Part D prescription drug plans (or PDPs) provide insurance coverage for your prescription drugs. Medicare Advantage plans (MAs or MA-PDs) provide your Medicare Part A coverage (In-patient and Hospitalization) and your Medicare Part B coverage (Doctors visits and Out-Patient care) - and maybe even Medicare prescription drug coverage.
Medicare Part D plans and Medicare Advantage plans are both voluntary programs and you are not required to join a plan. But you may be subject to a late-enrollment penalty if you decide to join a prescription drug plan sometime after your initial enrollment period has ended.
Medicare Part D plans and Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services (CMS or Medicare) and implemented by private insurance companies (such as Aetna, Humana, and United HealthCare).
If you decide to enroll in a Medicare Part D plan or Medicare Advantage plan, you will find that, like any insurance, you pay a monthly premium. The monthly premiums for a Medicare Part D PDP can range from under $20 to over $130 dollars.The monthly premiums for a Medicare Advantage plan with (MA-PD) or without (MA) prescription coverage can range from $0 (no kidding) to well over $100.
Medicare Part D and Medicare Advantage plans may have an initial deductible, co-payments or co-insurance, and some Donut Hole (Doughnut Hole) or Gap coverage (you can find more on these topics in our Glossary).
When you enroll in a Medicare Part D prescription drug plan or a Medicare Advantage plan that offers prescription coverage, you should find that your prescription medication costs are reduced. The amount of savings depends on the Medicare plan you select. If you wish to learn more, you can click on this link to view all of the Medicare Part D plans in your State!
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:: More information here in our Blog
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Choosing your Medicare Part D or Medicare Advantage Plan
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Trying to choose a Medicare Part D prescription drug plan (PDP) or Medicare Advantage plan? Medicare suggests that you look at Coverage, Cost, and Convenience - to these criteria we also add that you should probably consider the Company and your level of Comfort.
- Coverage - Are your prescription medications covered by this plan? Are there generic alternatives for your brand-name drugs? Can you work with this plan to get a formulary exception should you need a medication that is not covered on the existing formulary? What price-tiers apply to your medications? What health coverage does the Medicare Advantage plan offer beyond basic Medicare? Are there any additional benefits offered by the plan?
- Cost - What are the monthly plan premiums? Does the Medicare Part D plan or Medicare Advantage plan have an initial deductible? What are the co-payments or co-insurance that you pay for your medications or healthcare? What are the plan's coverage limits? Is there any prescription coverage in the Donut Hole?
- Convenience - How difficult is it to find a pharmacy or a health care provider? (Note: most national Medicare Part D plans have a pharmacy network of over 50,000 pharmacies.) Are your restricted to any healthcare network? Do your doctors accept this Medicare Advantage plan? How easy is it to work with this Medicare Part D plan or Medicare Advantage plan?
- Company - Is the company who provides the Medicare Part D or Medicare Advantage plan important to you? Often people choose a Medicare plan based only the Medicare plan provider's reputation or recommendation.
- Comfort - Are you comfortable with your current Medicare Part D plan or Medicare Advantage plan? Would you rather spend a few extra dollars per month because you have an idea how your current Medicare plan operates and your plan costs are predictable?
Still looking for more? Here are some general tips specifically for Medicare Part D prescription drug plan selection.
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:: Choosing a Plan: The Basics
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Enrolling into a Medicare Part D plan or Medicare Advantage plan
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Starting in 2011, you can enroll into a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage plan during the 2012 Annual Enrollment Period (or AEP) or open enrollment period starting October 15 and continuing for seven weeks through December 7 with your newly selected Medicare plan starting on January 1, 2012.
Please note that if you are just turning 65 or are newly eligible for Medicare, you will be granted a seven (7) month enrollment period when you can join a Medicare Part D or Medicare Advantage plan. The seven month period begins three months before your Medicare eligibility (or birthday) month, includes your eligibility month, and continues for three months after your Medicare eligibility month. However, your Medicare plan can begin no sooner than the first day of your Medicare eligibility month.
Enrolling in a Medicare Part D or Medicare Advantage plan is easy and takes little time.
: : Click here if you already know
which Medicare Part D plan you want
: : Click here to search for a
Medicare Part D plan
: : Click here to search for a
Medicare Advantage plan
The good news about enrollment is that you always pay the same amount for a Medicare D plan or Medicare Advantage plan, no matter where or how you enroll. As an expanded feature, we now provide enrollment options for all 2012 Medicare Part D plans and Medicare Advantage plans across the country. If you wish, you can also enroll directly with Medicare (1-800-Medicare) or with an insurance agent or the Medicare plan provider. No matter how you enroll in to a Medicare plan, the enrollment result should always be the same and in 7 to 10 business days you should receive your Medicare Part D new Member information.
Once enrolled into a Medicare Part D or Medicare Advantage plan, you can contact the plan's Member Services department with any questions or concerns. The toll-free number will be on the back of your Member ID card.
Please note that the new 2012Medicare Advantage Dis-Enrollment Period (MADP) for Medicare Advantage Plans beginsJanuary 1, 2012 and continues through February 14, 2012 -- during the MADP members of Medicare Advantage plans can switch back to original Medicare and join a stand-alone Medicare Part D drug plan.
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2012 Prescription Drug Search Tool: PDP-DrugFinder
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Looking for a simpler way to determine which 2012 Medicare Part D prescription drug plans cover a particular medication? Try our prescription drug search tool : PDP-DrugFinder. PDP-DrugFinder is designed for fast, single medication searches and provides plan details and cost-sharing information for your covered medication.
With PDP-DrugFinder, you can search for a medication different ways and find all the Medicare Part D plans in your state that cover your prescription drug or simply determine whether a specific medication is covered by your 2012 Part D prescription drug plan.
Is your particular medication also part of a local retailer’s drug discount program? Check our RxSavings-Finder to see if a lower discount price is available.
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Stay Informed with our Medicare Part D Newsletter
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Looking for the latest information on Medicare Part D prescription drug plans? Then join the thousands of people who receive our Medicare Part D Newsletter. Our free Newsletter is published on a regular basis and provides details on various areas of your prescription drug plan. The Newsletter presents new Medicare developments, frequently asked questions, and sometimes digs into more complex areas of Part D coverage. We also welcome reader input and suggestions for new topics. Complete the form below to sign up for the Newsletter. Please note, that we never share your personal information with other parties.
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What can we expect from 2012 Medicare Part D Plans?
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Each year the Centers for Medicare and Medicaid Services (CMS) publish a basic Medicare Part D benefit that is used as a standard for the design of Medicare Part D plans offered by private insurance carriers. The insurance carriers must provide Medicare Part D plans that at least meet the basic benefit offered by the CMS standard plan. The basic or standard 2012 Medicare Part D plan provides:
- Initial Deductible: The maximum initial deductible is $320. If your plan has a deductible, you would be responsible for 100% of your prescription costs while in the deductible phase.
- Initial Coverage Phase: After the deductible is met and until the plan negotiated retail costs of your medications reaches $2,930, you share the costs for your medications with your plan by paying a coinsurance or co-payments. The CMS Standard Model coinsurance is 25%.
- Coverage Gap (also known as the Donut Hole): After the initial coverage phase limit of $2,930 is reached and until your Total Out of Pocket (TrOOP) costs (not including plan premium) reaches $4,700, you pay 100% of the plan’s negotiated retail price for covered prescriptions. Using the CMS Standard Model plan, your prescription costs would be $6,658 when you exit the Donut Hole.
- Catastrophic Coverage: Once your total out of pocket cost (TrOOP or drug spending) has reached the Donut Hole or Coverage Gap cap of $4,700 (this amount does not include your monthly Part D plan premiums), you pay only 5% of the cost of covered drugs or a
co-payment of $2.60 for covered generics and $6.50 for covered brand-name
drugs, whichever cost is greater.
If you wish to see more detail click here to see a comparison of 2012, 2011, 2010, 2009, 2008, 2007, and 2006 standard Part D plans.
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Last updated on: 11/14/2011
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