Medicare Prescription Drug Plans
Medicare prescription drug plans are an important part of Medicare. They provide coverage for the medications that many beneficiaries require to live a full life. We will review some important facts about Medicare Part D and the role it plays when helping beneficiaries find the coverage they require.
Some facts about Medicare prescription drug plans (Part D):
Part D enrollment
Because enrollment in a Part D plan is optional, agents must make it clear that once beneficiaries reach their IEP, they should make sure they have credible Part D coverage. If the beneficiary does not enroll in a plan that provides creditable Part D coverage, they will be penalized when they finally do enroll. The Part B penalty will be applied to any Part D plan they enroll in for a lifetime.
If the beneficiary does not enroll during their IEP, they can use the AEP, which runs from Oct 15 through Dec 7 each year, to add Part D coverage.
Part D coverage choices
Beneficiaries can get Part D coverage through either a stand-alone PDP plan or through a Medicare advantage plan that includes Part D coverage also called a MAPD plan.
Insurance companies who receive approval from Medicare offer Medicare prescription drug plans. There are a wide variety of coverage options available. Plans offer different levels of coverage, a huge range of prices and different formularies. That is why it is important for Medicare agents to explain the different coverage options to clients.
You must get a list of medications each client currently uses. It is important to know the dose and how often they use each medication. The pharmacy a client uses also makes a difference in the plan choice they make. Agents should explain the total cost of each plan. This includes premiums, deductibles, copayments, and coinsurance. Enrolling in the wrong plan can be a very costly mistake.
Pharmacy network
Each plan offered has a network of preferred pharmacies. It is an agent’s responsibility to be sure that they are aware of which pharmacy their client prefers to use. If the client uses the wrong pharmacy, it can significantly raise the client’s out-of-pocket cost substantially.
Part D phases of coverage
As an agent. it is necessary that each beneficiary understands the Part D coverage phases. This can be confusing to many people. These phases include the deductible, initial coverage phase, the coverage gap also called the “donut hole”, and finally catastrophic coverage. During each phase, beneficiaries pay different amounts for their medications.
Each client has their own list of prescriptions therefore some people will remain in the first stage all year while others will reach the catastrophic stage.
Additional Part D information:
Medicare puts protection in place for beneficiaries. This includes the ability to appeal denials of coverage for non-formulary medications as well as the chance to change plan coverage during certain enrollment periods.
The opportunity to change plans comes each year during the AEP. This time of year, Medicare agents need to review any plan changes by reviewing their plans ANOC. Medicare plan providers may change their formulary each year. Therefore, it is imperative to get an updated medication list for every client each year to see if there are better options available for the coming year.
Extra help
Because some individuals have limited income and resources, you need to help direct them to the extra help programs that may be available through either the state or federal government. Extra Help programs can help with Part D costs. This can reduce out-of-pocket expenses.
Agents need to take time each year and compare the plan choices available to their clients. This will ensure that the plan chosen will fit the clint’s needs and budget. It will also help beneficiaries avoid surprising expenses whenever possible.
One of the things that make a Medicare agent good at his job and helpful to clients is understanding what he is offering.
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