Kristin P Sinclair – A Accu Tax Oct 8th 2018 – Rock Hill, SC – Charlotte, NC
Stand Alone Medicare Part D plans have a monthly premium, that you pay to have the plan service your prescription drug coverage needs for the annual period. You want to pay the premiums in a timely fashion when due. Choosing a plan that you can afford is one of goals that you want to achieve. Your premium costs do not go toward your out of pocket costs when you tally your drugs copays and coinsurance figures. Premium paid is one set of costs. Out of pocket costs for copays and coinsurance is a separate set of figures.
Medicare Part D has an annual enrollment period. From Oct 15th through Dec 7th. When you change your plan during this annual enrollment period the new coverage begins Jan 1st in the upcoming year.
If you move from one coverage area to another, say from South Carolina to North Carolina, during the annual period, you have a Special Enrollment Period to change to a plan in your new State. You will not automatically have a new plan in your new state, you need to be proactive getting this done before your SEP period has ended.
If you become eligible for extra help and receive a Low Income Subsidy to help offset a portion of your costs you have Special Enrollment Periods during the year to make some changes if your RX needs change and a formulary change is needed.
You can see the government has created protections for you as a medicare beneficiary. But as a general rule, once you choose a plan that will be your plan for the annual period. Take the opportunity to do your research each year. Choose the plan that is most suitable for your situation, and factors you know to be the case at the present moment in time.
Each year you could see some changes to your plan. You will receive An Annual Notice of Change. ANOC describing what is changing on your plan. This notice is a good reminder to gather your medication list and review the changes coming to your current plan for the upcoming annual period.
Review medications covered on the formulary. That is the list of medications that your plan covers. This formulary also provides the cost sharing tier detail as well.
Review your local pharmacy choice, your mail order pharmacy choice. Which Tier your medications will fall into. Since medications can move from one tier to another from one annual period to the next, it is prudent to review how the formulary and tier structure will affect you in the upcoming annual period.
Schedule an appointment with a trusted resource to get some idea of plan costs, RX costs, and idea of the stages you should plan for. Call your Insurance agent, schedule an appointment to review your RX and plans that cover the medications you are taking. Kristin can be reached at: 803-329-0615. Call to schedule an appointment. While sitting down with your computer go to: www.Medicare.gov this is a great resource, but wait until the annual enrollment period to get into the program that www.Medicare.gov offers for your research. They have a lot of data they are populating into the data base. Allow them time to help you do your comparisons.
For Plans that have a deductible in 2019, $415.00 is a number you will see on many plans with a deductible. Not all plans have deductibles, some plans have deductibles on only certain tiers on the formulary. So have pencil and paper ready when you do research. Make note of things important to you.
Medicare Part D is designed to have various stages. An initial stage you will have copays or coinsurance cost sharing after any applicable deductible has been met. Most people do not leave the initial stage during the annual period. Taking generic alternatives and opting for 90 mail order can help your dollars go further. When your plan offers various tiers and mail order incentives to save.
It could be possible that you have spent $1,000.00 out of pocket, but the true cost of medication cost have reached a figure of $3,820.00. After the total drug costs reach $3,820.00 that is when the coverage gap, also known as the donut hole begins. While you are filling your medications in the coverage gap stage, the cost sharing changes. 37% coinsurance for generic drugs or 25% coinsurance for name brand drugs. The drug manufacture also pays 25% toward your medication cost for the name brand drug as well. And the other costs are paid by the plan as well.
What does this mean, well you might be taking an expensive generic drug and while you are in the coverage gap, you will pay 37% of the cost. You might be taking an expensive name brand drug and while you are in the coverage gap, you will pay 25% of the cost.
Some plans offer some additional cost sharing while in the gap. Those plans are often going to have a higher premium. And when you consider this plan design, look at the total annual costs for the factors that you can plan for. A years total cost can vary significantly based upon the plan chosen, sometimes a lower premium and use of mail order can help make your dollars go further. The medications you are taking, the formulary on the plan chosen, need to work for you, so do your research. Choose wisely grasshopper. Decide when higher premiums are going to offer a plan that saves you money. Or could a plan with a lower premium actually by years end actually have saved you more on out of pocket costs. It depends.
Once your out of pocket cost for the medications filled through the local pharmacy or through mail order, reach $5,100.00, you enter into the next stage which is called the catastrophic coverage stage. During this stage you will pay the greater of $3.40 copay for generic, (including brand name treated as generic) , $8.50 copay for name brand medications, or you could pay 5% coinsurance. If you do enter the catastrophic coverage stage, you will be in the stage until the years end. When the new annual period begins, the various stages will start again.
Kristin P Sinclair A Accu Tax
Rock Hill, SC Charlotte, NC
Some other thoughts, people who receive extra help to offset their RX out of pocket costs might have cost sharing that is different than others also receiving extra help, there are different types and levels of extra help. It is possible for a plan to cost different amounts for people on LIS. In the same state or area of service for a plan.
Most Medicare Part D beneficiaries do not receive extra help in the form of LIS, Low Income Subsidy however, for those who need extra help it is certainly good it is available. A Person would need to look into this to determine if they qualify annually.
Look at Star Ratings for the plans you are reviewing. If the plan is new, it will not yet have a star rating. If the plan has been around for several years, it will have a star rating for you to review.