What is the Medicare Prescription Drug plan? How does the donut hole work? How can I avoid the donut hole? What if I can’t afford my prescription drug? Does Medicare cover vaccines? Doesn’t Medicare Part B cover prescription drugs? Why do I have to pay more because of my income. When is open enrollment?
24 prescription drug plans are available in 2016 including three new plans. Seven plans have been discontinued for 2016
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Picking the right Medicare drug plan
October 15th is right around the corner and about 35 million retirees will have 7 weeks to review their current plan, compare it to new 2015 plans and sign up before midnight December 7th.
The number of plans available for 2016 will be slightly lower than 2014, just slightly over 1000 plans nationwide. More plans are expected to have deductibles and $0 copay generics may be a thing of the past.
The 2016 co-branded Humana WalMart plan will experience a 14% increase in the monthly premium.
The Humana Walmart prescription drug plan still has the lowest premium in 2016 (but not necessarily the lowest cost).
Wellcare Classic changes their premium from $28.90 with a $320 deductible for 2015 to a monthly premium of $27.00 and increases the Rx deductible to $360. Probably other hidden surprises in there, such as higher copay’s.
The co-branded AARP/UHC plan jumps from $27.00 to $37.40 for 2016 and adds a $360 deductible.
Compare your current plan to the 2016 plans using the Medicare Plan Finder.
Georgia Medicare Plans is happy to assist our Medigap clients in finding the right plan for their needs. There is never a charge for our service.
If you are not a current client and would like to compare plans and rates for Medicare supplement plans we invite you to take advantage of our FREE instant quote engine. Click to shop and compare plans.
Medicare donut hole
The confusing donut hole is back and more expensive.
In 2014 you hit the prescription drug donut hole (actually a corridor deductible) once you had run $2850 in covered drugs through your plan. For 2015 that amount increases to $2960.
Obamacare does promise to eliminate the donut hole in increments by 2020 the trade off is higher premiums, higher deductibles and higher copay’s. So while only 6% of Medicare beneficiaries hit the prescription drug donut hole, because of Obamacare everyone’s cost for Medicare Part D will increase.
Escaping the prescription drug donut hole
The donut hole only impacts those who run more than $2960 (2015) in medications through their drug plan. One way to avoid the hole is to switch to lower cost medications, including generics. Another is to purchase your drugs outside of Medicare Part D. This would be medications where you pay cash as well as those bought from other countries including Canada.
We recommend and use Blue Sky Drugs.
The more medications you run through your prescription drug plan, the quicker you get to the donut hole.
Medicare supplement clients of Georgia Medicare Plans receive no charge consultations on ways to lower their prescription drug costs.
With so many choices, how do you keep it all straight?
Sometimes a glass of wine helps ……..
Some vaccinations are covered under Medicare Part B, some by Part D. If the vaccine is administered in your doctor’s office the office visit should be covered under Medicare Part B. The cost of the vaccine may also be covered under Part B.
Part B covers vaccines for Hepatitis B if you are a high risk patient. You may also have Part B coverage for flu vaccines and pneumonia.
Preventive vaccines not covered by Part B must be covered by Part D.
For more details review this publication from the Medicare Learning Network.
Medicare Part B medications
SOME prescription drugs are covered by Medicare Part B. As a general rule, most infusion therapy drugs are covered by Part B. Some drugs can be covered by Medicare Part B or Part D depending on the condition and the way the prescription is written.
A few examples of Part B drugs include:
- medications used with DME such as infusion pumps or nebulizers
- some antigens
- injectable osteoporosis drugs
- blood clotting drugs
- flu shots, pneumococcal vaccinations and Hepatitis B shots
- immunosuppressive drugs
Making drugs affordable
If you are having trouble paying for your medication there are several assistance programs through Medicare and Social Security.
Details on the Medicare Extra Help programs are available here.
You may also qualify for different levels of help through the Medicare Savings Program. Options QMB, SLMB, QI and QWDI are outlined in the Medicare Savings Program link
Medicare additional charges
If you are in what Medicare considers a high income bracket you may have to pay a surcharge on your Part B and Part D premium. If you purchase a Medicare Advantage plan that includes a prescription drug benefit you are also subject to a surcharge.
If you think you may be hit with a surcharge, this Medicare pamphlet may help.
Social Security uses your MAGI (modified adjusted gross income) from prior years tax forms to determine if there is a penalty and how much to charge. Your MAGI is your AGI (adjusted gross income) PLUS deductions for IRA contributions, deductions for student loan interest.
Your AGI starts with gross wages, self employment income, taxable dividends and interest, alimony, pension benefits (including RMD) and the taxable portion of your Social Security income.
Income surcharges are deducted from your Social Security check.
Navigating Part D options
It doesn’t matter if you have original Medicare, a supplement and Part D or if you are enrolled in a Medicare Advantage plan that includes prescription drugs. Every year during open enrollment you MUST compare your current drug plan to the new options. If you fail to do so you could very well end up paying more than you should for your plan, your medications, or both.
Georgia Medicare Plans is always happy to assist our current Medigap clients in reviewing prescription drug plan options and offering suggestions on ways to minimize your out of pocket costs.
Shop and compare plans now.
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