The Medicare prescription drug benefit, also called Part D, is available to anyone enrolled in Medicare. This drug coverage is offered by private insurance companies. There are two types of plans to choose from.
- You can choose to receive your medical benefits from the traditional Medicare program and receive prescription drug coverage through a Medicare drug plan.
- You can join a Medicare Advantage Plan with drug coverage. Medicare Advantage Plans provide another way to receive your Medicare benefits including drug coverage.
There are several plans to choose from in Iowa. If you join a plan you will pay a monthly premium and pay some of the cost of your prescriptions. How much you pay, what drugs are covered, and which pharmacy you use will vary depending on the plan you choose.
This is how the basic Medicare drug coverage is designed for 2012 (though plans are allowed to offer variations of this design):
- You will pay a monthly premium. In Iowa, stand-alone drug plan premiums range from $15.10 to $106.50 a month and Medicare Advantage plans from $0 to $165 a month. Individuals with incomes above $85,000 ($170,000 couples) will pay a higher Part D premium.
- You will have to pay the first $320 of your drug costs each year. This is called a deductible. Some plans offer a lower or no deductible.
- After you pay the deductible, Medicare will pay 75% of the next $2,610 of your drug costs. You pay 25% of these costs or $652.50.
- After total drug costs (what you pay and what the plan pays) reach $2,930, you will pay more of your drug costs on the next $3,727.50. This is called the coverage gap or doughnut hole.
- Once your out-of-pocket drug costs (what you pay not including premiums) reach $4,700 ($320 deductible + $652.50 coinsurance + $3,727.50 coverage gap) Medicare will start paying 95% of your drug costs.
- Plans may offer additional benefits which can increase premium costs.
You are eligible for the Medicare prescription drug coverage if you are enrolled in Medicare Part A and/or Part B. New Medicare enrollees will be eligible to enroll in the prescription drug coverage when they enroll in Medicare. Individuals who do not enroll in the drug benefit when they are first eligible will have to wait to enroll in a plan until an open enrollment period. This runs from October 15 to December 7 each year. Their coverage will then begin January 1 of the next year.
Note: You may have to pay a higher premium if you don’t join a plan when you are first eligible or you don’t have an existing drug plan that is equal to or better than Medicare coverage. You will pay at least 1 percent more for every month you wait to get a Medicare prescription drug plan. The penalty is a percentage of the national average premium ($31.08 in 2012) for Medicare drug plans. And you will pay this higher premium for the rest of your life.
However: Individuals who currently have prescription drug coverage as good as Medicare’s coverage from an employer or union plan may not want to enroll in a plan when they are first eligible. If your current drug coverage is “creditable” (as good as, or better than Medicare’s coverage), you do not need a Medicare Part D plan right away—and can get one later without having to pay any late-enrollment penalty.
Tips for managing the “donut hole” coverage gap:
1. Keep using your Medicare prescription drug card.
- Plan prices are generally lower than retail cost.
- The money you spend will count toward the $4,700 you need to spend in order to receive catastrophic coverage benefits.
2. Switch to generic or less expensive brand-name drugs.
- Contact your doctor to see if you can change to a generic. This could reduce your co-payments and help maximize savings.
- You may be able to lower your costs if your doctor will prescribe double your dosage, (e.g. 20mg instead of 10mg), and you cut the tablet in half. You will only need to purchase 15 pills a month instead of 30. It is very important to check with your doctor as this cannot be done with all medications.
- Check with your Part D plan to see if you could save money using mail-order.
3. Try to avoid reaching the gap.
- You can ask if your pharmacist to not apply certain drugs to your Part D card.
- Check into purchasing generic drugs through low cost programs available at some chain stores such as Wal-Mart, Target and K-mart. To avoid using multiple pharmacies, ask if your pharmacy will match these programs.
4. Explore other available assistance.
- Contact the Social Security Administration to see if you qualify for extra help in paying for your prescription drug plan.
- Look into Patient Assistance Programs. Many of the major drug companies offer assistance programs. You can find out if assistance is available for the drugs you take by going to www.medicare.gov and select “Health & Drug Plans” and “Coverage Gap Information.” Then click on Pharmaceutical Assistance Program.
- Ask your doctor about free samples for your prescription.
5. Review your current plan and do a comparison to determine if you should change to a plan that provides coverage in the gap the next time you enroll.
- Plan ahead for the gap. A comparison will give you an estimate of your yearly costs including what month you will reach the gap. Divide your costs by 12 and set aside enough money to cover your costs when you reach the gap.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Iowa. 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.