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Medicare Part D

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Medicare Part D

Part D is the area regarding your prescriptions while outside the hospital.  Below is information that will give you more insight on how this government program works.   We would suggest the most cost-effective and beneficial way of finding the best Part D plan for you is to go to your pharmacy where you get your prescriptions and check with them what plans they have for you.

Below is more information on Part D, as well as a graph that shows your out-of-pocket expenses:

  • Part D program began January 1, 2006.
  • Coverage of Medicare Part D benefits is provided by private companies.
  • Medicare pays a share of the program costs.
  • Individuals entitled to Part A and/or enrolled under Part B are eligible for Part D.
  • Part D coverage is provided through network pharmacies in the Part D service area.
  • The types of Part D plans are:
    • Stand-alone Prescription Drug Plan (PDP)
    • Medicare Advantage-Prescription Drug (MA-PD) Plan:
      • An MA plan that also covers Part D prescription drugs
    • Cost-PD Plan
      • A Medicare health plan that covers Part D prescription drugs as an optional supplemental benefit.
  • The beneficiary must live in the plan?s service area.
  • For 2010, the standard benefit requires the beneficiary to pay:
    • $310 deductible
    • 25% of costs between $310 and $2,830 = $630
    • 100% of the next $3,610 in drug costs (the ?coverage gap?), then
    • After the beneficiary has paid $4,550 out-of-pocket, catastrophic coverage begins.
      • On any future prescriptions th ebeneficiary pays either a co-pay of $2.50 for generic drugs or $6.30 for brand name drugs or a co-insurance of 5%, whichever is greater.

 

medicare_d_chart_2010

 


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