What Is Medicare Part C And D?

What Is Medicare Part C And D?

Learn how medicare part C and D work to keep you healthy.

Medicare Advantage (Part C)

The Medicare Advantage Prescription drug plans (MA-PDs) are Medicare prescription drug benefit plans that are offered by private companies, called Medicare Advantage organizations (MAOs). Each Medicare Advantage Prescription drug plan has its own list of covered drugs. Enrollees can choose between different Medicare Advantage prescription drug plans offered by the same Medicare Advantage organization. Enrollees are generally allowed to switch between Medicare Advantage prescription drug plans within the same organization if they wish to do so.

Medicare Advantage Prescription Drug Plans (MA-PDs)

Medicare Advantage Prescription Drug Plans (MA-PDs) are offered by private companies, called Medicare Advantage Organizations (MAOs). Each Medicare Advantage Prescription Drug plan has its own list of covered drugs. Enrollees can choose between different Medicare Advantage Prescription Drug plans offered by the same Medicare Advantage Organization. Enrollees are generally allowed to switch between Medicare Advantage Prescription Drug plans within the same Medicare Advantage Organization if they wish to do so. The Medicare Advantage Prescription Drug plans are referred to as Part C plans. Enrollees in Part C plans are also eligible for preventive care services, medical care, and other benefits for which they are eligible under Part A and/or Part B. Medicare Advantage Prescription Drug plans are not required to cover the Part B deductible and coinsurance amount.

Part D

Medicare Prescription Drug plans (PDPs) and Medicare Advantage Prescription Drug Plans (MA-PDs) are managed by private insurance companies that are licensed by Medicare. PDPs are offered by private companies that are contracted by Medicare to sell drug coverage to enrollees. The plans are called Part D plans. Enrollees can choose between different PDPs. Enrollees in Part D plans are also eligible for preventive care services, medical care, and other benefits for which they are eligible under Part A and/or Part B. Enrollees in Part D plans are responsible for paying a monthly premium. Enrollees can choose to pay a monthly premium that is higher than the premium they would pay for a PDP in order to purchase a lower deductible or lower copayment (i.e., coinsurance) amount.

What is low income subsidy (LIS)?

The low income subsidy (LIS) program is a no-cost, no-deductible drug benefit for Medicare beneficiaries with limited income and resources. All Medicare beneficiaries who are eligible for the LIS program may receive their Part D drug benefit for free and have no monthly premiums or deductibles. They will only pay a small amount for each prescription drug. This amount is called the co-payment for brand-name drugs and the co-insurance for generic drugs. However, they will have to pay the full retail cost of the prescription drug up to the catastrophic level. The LIS program is for low-income people who pay little or no Part B premium.

Who is eligible for LIS?

If someone has limited income and resources, he or she may be eligible for the LIS program. Limited income means that monthly income is less than or equal to $817.00 for 2018. Resource means the total value of cash and property that is not used for personal or family living expenses. The resource limit for 2018 is $3,110.00.

How do I determine if I'm eligible for LIS?

Medicare beneficiaries can call 1-877-690-1012 to find out if they are eligible for the LIS program.

What are the monthly premiums for LIS?

Enrollees who buy a Part D or Medicare Advantage prescription drug plan pay the same monthly premium that others pay who have comparable coverage. This is called the standard monthly premium. The monthly premium for an LIS enrollee is always lower than the standard monthly premium. This is so that LIS enrollees can have the same coverage that others have.

Is LIS a no-deductible drug benefit?

LIS enrollees pay a low amount for each prescription drug. However, they will have to pay the full retail cost of the prescription drug up to the catastrophic level.

How do I get LIS?

LIS is a no-cost, no-deductible drug benefit. However, participants will pay a small amount for each prescription drug. This amount is called the co-payment for brand-name drugs and the co-insurance for generic drugs. However, they will have to pay the full retail cost of the prescription drug up to the catastrophic level. The LIS program is for low-income people who pay little or no Part B premium.

What if I change plans or leave the LIS program?

LIS enrollees should contact their current plan or the local Social Security or Supplemental Security Income (SSI) office to notify them of the change. LIS enrollees may change plans by using the “Medicare Select” enrollment period, during the first three months of each year. They may also change plans during the general enrollment period throughout the year.

What is the Part D coverage gap?

The Part D coverage gap is a period when you pay 100% of the cost of your drug while your prescription drug plan pays nothing (coverage gap in generic drugs). Once you reach the coverage gap limit, you pay only a small amount for each brand-name or generic drug (co-payment). LIS enrollees also pay a small amount on each prescription drug (the co-payment for brand-name drugs and the co-insurance for generic drugs).

What is the Part D formulary?

A formulary is a list of drugs that a health plan covers. A formulary can be a list of prescription drugs that is issued by the health plan or it can be a list that is issued by the Medicare program. A health plan can issue a formulary

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