Is Medicare Part D Mandatory?

Is Medicare Part D Mandatory?

A: You need to bring your prescription with you, if the drug you want to buy is not on the approved drug list.

Q: Are prescription drugs free under medicare part d?

A: Most prescription drugs are not free. They are covered at different levels, depending on the plan you have chosen.

Q: Are generic drugs cheaper under medicare part d?

A: No, they are not.

Q: What is the difference between generic and brand name drugs under medicare part d?

A: A generic drug is a drug that has the same chemical composition and effect as its brand-name counterpart.

Q: What are the copays for drugs on medicare part d?

A: The copays vary from plan to plan.

Q: Does medicare part d cover all prescription drugs?

A: No. Part D covers a "formulary," or a list of drugs that it will cover.

Q: How do I know what drugs are on the medicare part d formulary?

A: You can find information about the formulary on the Medicare website.

Q: Will medicare part d pay for prescription drugs that I receive in a hospital?

A: No, only if you receive those drugs at home.

Q: Will medicare part d pay for biologics?

A: No.

Q: Are there any other limitations on the drugs that medicare part d will cover?

A: Yes. There are five categories of drugs that Part D does not cover:

• drugs that are not on the Part D formulary

• drugs that require prior authorization

• drugs that require a step therapy program

• drugs that require a dispensing fee

• drugs that deliver a compounded formulation

Q: What is a medi-gap insurance plan?

A: A Medicare Prescription Drug Insurance plan commonly referred to as a Medigap Plan. The U.S. Government issued a publication titled, "Medicare Guide to Choosing a Medigap Insurance Plan." It is available from the Medicare website at www.medicare.gov.

Q: How do I know if I should purchase a medigap insurance plan?

A: The following are some of the items to consider:

• You are the only person in your household on Medicare.

• You are married and both you and your spouse are on Medicare.

• You are a married person and your spouse has Medicare but you do not.

• You have dependents who have Medicare.

• Your spouse has dependents who have Medicare.

• You are a single person who has Medicare and dependents who have Medicaid.

Q: How do I determine whether I have coverage for specific services?

A: You can call your local Social Security office. The number is in your local telephone directory. If you prefer to reach the Social Security office online, access the Social Security website at: www.ssa.gov.

Q: What if I do not have a computer?

A: The Social Security office provides a toll-free number to call. The number is: 1-877-690-1012.

Q: Am I eligible for help paying for Medicare prescription drugs?

A: Yes. To get this help, you must meet certain requirements. You must be eligible for Medicare, and your income and assets must be below certain limits.

Q: How do I determine whether my income and assets are above or below the limits?

A: You can find information about the income and asset limits on the Medicare website.

Q: Are there other programs that will pay for my prescription drug costs?

A: Yes. You may also be eligible for help from private insurance and from the pharmaceutical companies.

Q: What are some of the private insurance programs that I may be eligible for?

A: Some of the programs include:

• Your employer's retiree health insurance plan

• Your former employer's retiree health insurance plan

• Health insurance that you purchased yourself

Q: What is the Medicare coverage gap?

A: The Medicare coverage gap is also known as the “doughnut hole”. This is a coverage gap in Medicare Part D.

Q: When will I enter the coverage gap?

A: You will enter the coverage gap in 2011, when you spend more than $2,830 on prescription drugs.

Q: How do I know whether I am in the coverage gap?

A: The information about whether you are in the coverage gap will be included in the plan information that you receive from your plan.

Q: What happens if I reach the coverage gap?

A: If you reach the coverage gap in 2011, you will pay the full drug cost for the rest of the year.

Q: How will I know when I have reached the coverage gap?

A: Your plan must give you a notice at the beginning of the year, telling you the amount of prescription drug expenses that are covered by your plan, the amount of prescription drug expenses that you must pay, and the amount of drugs that you must pay for out of pocket.

Q: What are the costs that I will pay?

A: In 2011, the only costs that will apply to you in the coverage gap are your Part D plan's copayments (if you have a standard Part D plan), and the premiums that you must pay for your Part D plan.

Q: What happens after I reach the "doughnut hole"?

A: In 2012, your share of the costs in the coverage gap will decrease. You will only pay 25% of the cost of your prescription drugs in the coverage gap. The drug manufacturer will pay the rest.

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