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2016 Medicare Plans Offering Prescription (Part D) Coverage
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If you are looking for extra Medicare coverage in 2016 you can use this guide to help compare Medicare Advantage plan and premium information for Medicare plans offering part D coverage. Previous Medicare enrolled seniors cant start signing up until October 15 2015. Open enrollment runs through December 7 2015.
Understand how Medicare Part D worksMedicare Part D sometimes called "PDPs" is a subsidized prescription drug program backed by the US Federal government that provides anyone on Medicare access to medications at reduced rates. All Medicare Part D plans have some basic benefits that are required by Medicare, since it is regulated by the government.
How much does Part D cost?The premium for a Part D drug plan averages to about $31 a month. Depending on the plan you choose you may have a drug deductible to pay which can be as high as $310/year. The higher the plan D premium, the less chance you will have a deductible to meet. Most Part D plans cover drugs based on a 4 or 5 tier system. You pay a co-pay or coinsurance for your medication depending on which level or tier it falls under. You pay your set out-of-pocket expense for each drug you take until you and your plan together, are out-of-pocket $3310 for the year for your medications. At which time you have entered what is called the “Coverage Gap” or “Donut Hole” when you will pay 45% of the plans cost for covered brand-name prescription drugs unless your plan offers additional coverage. During the Donut Hole you will get a 55% discount on brand drugs that are covered by the plan. For generic drugs that are covered by Part D you will be responsible for 58%. The good news is the 55% discount on brand drugs is also counted towards your out-of-pocket, which will help you close the coverage gap even quicker. Once you reach a total of $4850 in out-of-pocket expenses for Part D covered medications between themselves and the plan, then the insured enters what is called “Catastrophic Coverage”. This is when you only pay a small co-pay or coinsurance for each drug until the end of the year.
Medicare Part D Drug FormulariesYou might be surprised to find out that Part D prescription drug plans are not required to cover all Medicare approved medications. Every drug plan for seniors has a different but similar medication list known as a formulary. The Part D drug plans can set their own drug formulary as long as they follow the established guidelines set by the United States Pharmacopoeia. What you will want to do if you currently take any medications is sit down with a list of your medications, and figure out what your co-pays would be for the top three drug plans in your county. You can also utilize a insurance agent who is contracted with Part D companies to assist you with drug plan comparisons at no additional cost to you whatsoever.
Medications Not covered by Part D
- Medications that are not approved by the FDA
- Medications not available to sell in the United States
- Medications which are covered under Part A or Part B of Original Medicare
- Any medication use for weight loss or weight gain
- Fertility medications
- Medications for sexual disorders such as erectile dysfunction
- Medications used for cosmetic purposes such as Rogaine for hair growth
- Medications for the common cold or cough
- Nonprescription drugs
However, the above medications may be covered if they are prescribed to treat other conditions. For instance, prescription medications for the relief of the common cold may be covered by Part D if prescribed to treat severe asthma or shortness of breath.
Medicare Part D EnrollmentWhen you first become eligible for original Medicare Parts A and B, you have seven months to sign up for a Part D drug plan. During that time you can not be declined for a drug plan based on your health history you are what is called guaranteed issue. After your initial enrollment is expired every year there is an annual enrollment period between October 15 and December 7, this is when you can change drug plans and your change would go into effect the following January. If you elect not to sign up for a drug plan when you first become eligible, but decide later to sign up for coverage you will pay a Medicare Part D penalty of 1% for every month you did not have the Part D plan but were eligible. If you decide to join a Medicare drug plan, the plan will tell you if you owe a penalty, and what your penalty will cost per month.
2016 Standard Plan Changes
|2016 Standard Benefit Changes|
|Initial Coverage Limit||$2,960.00||$3,310.00|
|Catastrophic Coverage Begins||
|Coverage Gap |
*In addition to the 55% discount on covered brand-name prescription drugs