Medicare Prescription Drug Coverage helps cover the cost of your prescription drugs. You must first enroll in Medicare Part A or B, or both, to be eligible to enroll in Part D. All plans must offer at least the minimum standard benefits determined by Medicare but may offer significantly more coverage. The premium for this coverage will range from less than $30 per month to a maximum of about $115 per month and there may be an annual deductible of up to $320 in 2012.
Medicare standard benefit: After the deductible is met, patient pays 25 percent of the prescription drug costs and Medicare pays 75 percent until total prescription drug costs reach $2,930. Patient then pays 100 percent of prescription drug costs until the total prescription drug costs reach $4,700.
After the total prescription drug costs reach $4,700 you will pay a 5 percent co-pay per prescription and Medicare will pay the remaining 95 percent. The above illustrates only the minimum standards set by Medicare. There are many plans available that have lower or zero deductibles and that provide some or complete coverage through the gap or “donut hole” where the minimum standard plans would not provide coverage. There is a 50 percent discount applied to brand name drugs and a 14% discount applied to generic brands through the “donut hole” as part of the Affordable Care Act (ACA).
For beneficiaries with lower incomes, extra help (Low Income Subsidy or “LIS”) is available through the Social Security Administration to pay all or part of the Part D premiums and co-payments. Most significantly, people with Medicare who are also eligible for Medicaid, will receive full premium subsidy, full subsidy of the deductible and minimal co-pays, usually $3-$6 per prescription.
Additional assistance is available through the Big Sky Rx program administered by the State of Montana (1-866-369-1233) for people who do not qualify or only qualify for partial assistance through Social Security. The Big Sky Rx program can still help many Montanans pay for all or part of their Part D Premiums. For further information, call the CSI at 1-800-332-6148 or the Montana SHIP (State Health Insurance Assistance Program) at 1-800-551-3191.
Note: If a Medicare beneficiary currently has a Medicare Supplement policy plan H, I or J which contains a limited benefit for prescription drugs, these policies will not be considered as creditable coverage with regard to the late enrollment penalty for Medicare Part D. Although these Medicare Supplement plans are no longer sold, some Montanans may have elected to keep their plans with drug benefits and may continue them as long as they wish.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Montana. 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.