The Medicare Prescription Drug Standard Plan is the model for minimum standards all Medicare PDP’s must meet.
There is a monthly premium. It can be deducted from your Social Security check, the plan can debit your bank account each month, or you can pay the plan directly. There may be an annual deductible. For example: In 2010, the deductible could not be more than $310 per year. Some plans have a reduced deductible or none at all.
If your plan has a deductible, you will need to pay the amount of the deductible before your coverage begins. After you have met your deductible, you enter the Initial Benefit Period, during which your drug plan pays 75 percent of the cost of each prescription and you pay 25 percent (of the next $2520 in drug costs). The most you will pay during the Initial Benefit Period is $630 (25 percent of $2520).
Once the total cost for medications reaches $2830, you enter the Coverage Gap (also called the “Doughnut Hole”). You will then pay 100 percent of all prescription costs until you have spent another $3610 out-of-pocket. (Some PDPs will pay for some generic drugs in the coverage gap.)
Once you have spent a total of $4550 ($310 + $630 + $3610) in allowable True Out-Of-Pocket costs (sometimes called by the acronym TrOOP), you are eligible for Catastrophic Coverage. For the remainder of the year, Medicare will pay 95 percent of your prescription drug costs. You pay 5 percent of each prescription or a $2.50 generic/$6.30 brand-name co-payment—whichever is greater.
Each Medicare-approved PDP offers its own list of covered drugs, called a formulary. Formularies vary from plan to plan. Medicare approved plans offer a choice of at least two drugs in each of 146 prescribing categories. They cover insulin, insulin supplies and stop-smoking drugs. They also cover all drugs in the following six categories: anti-depressants, anti-psychotics, anti-convulsants, anti-cancer, immuno-supressants and HIV/AIDS medications.
Before deciding on a plan you should carefully review its formulary, if a drug is not on the plan’s formulary then it will not be covered and you will be responsible for the cost.
A note: In terms of drug coverage, Medicaid programs may offer broader coverage than Standard Part D plans. For example, ConnPACE (a prescription drug plan for people over 65 that is part the state’s Medicaid system) will cover barbiturates and benzodiazepines not on formulary.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Connecticut. It is for informational purposes only and some listings may be inaccurate or missing. The list was provided by the Centers for Medicare and Medicaid Services (CMS), but due to the variance in plans based on county, city, and region, some options may not be available in your location.