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Medicare Part D Plans and Coverage #2 – What To Consider

In the first post in the short series we looked at several things to consider when shopping for Medicare Part D Plans and what coverage the different plans offer. Now we will continue with additional points to consider.

Examine the Red Tape

A majority of the plans will have red tape. For instance, a few Part D drug plans might make you have a prior authorization, PA, before the plan will pay for the cost of the drug. Which means that your doctor will have to give more information as to why you need the drug before the drug will be paid for. Several plans may make you try generic or cheaper drugs. They may also put a limit that can be purchased at once, which may affect the access to your medications.

Examine the Gap Coverage

Many plans have a donut hole, or a coverage gap. Once your drug spending gets up to $2,840 is when the donut hole begins. Once $4,550 out of pocket expenses is reached then the donut hole closes and catastrophic coverage will start. Beneficiaries that reach the donut hole in 2011 will start to see some decreases in cost because of the Affordable Care Act. For instance, during the hole, 50% will be taken off of brand name drugs and the Part D coverage pay for 7% generic drug costs.

Examine the Late Enrollment Penalties

Once you reach 65 years old or your prescription drug plan through your employer is lost then it is advised that you sign up for a Medicare Part D plan. If you do not have a drug plan for over 63 days then you will be given a late enrollment penalty. In 2011, these are calculated by multiplying the 1% of the base national premium by the number of months that you were eligible for a plan. So given this formula, the longer you wait the more penalty that you will have to pay. This penalty is added onto the monthly premiums for the rest of your coverage but may go up if the base national beneficiary premium goes up.

Your Examination Might Be Limited

Since new regulations are starting to duplicate and have lower enrollment, there will not be as many options this next year. It is figured that only 1,109 prescription drug plans will still be offered in 2011 nationwide and the average beneficiary will have roughly 33 drug coverages to choose from. If you do not choose a new plan by yourself then if you are part of an eliminated plan you will be assigned a different plan in 2011 with the same provider.

We hope this answers some of the questions you may have about Medicare Part D Plans and coverage but if you would like to know more please call us at Heritage Companies at (816) 322-6350.

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