Prescription Drug Plans – PDP

Medicare Prescription Drug Plans?

When considering Medicare Prescription Drug Plans or (PDP), keep in mind there is no one size fits all. The plan your neighbor or friend bought may not be the best plan for you. Here are some key facts that you need to know.

Who is eligible to apply for Medicare Prescription Drug Plan?

If you have Medicare Part A or Medicare Part B, you can purchase a Prescription Drug Plan. There are no physical exams required. You cannot be denied coverage because of current or past health reasons. And your premium is not based on your medical conditions; past, present, or future.

Do I Have to Sign up for Prescription Drug Coverage?

The decision to join a Medicare Part D Drug Plan is yours. However, if you now get your prescriptions from Medicaid, you must get them from a Medicare Prescription Drug Plan as soon as you become eligible for Medicare.

If you do not enroll when you first become eligible, you may incur a Late Enrollment Penalty (LEP). The penalty is determined by multiplying 1% of the “national base beneficiary premium (also called the Benchmark premium) which for 2014 is $32.42, 2015 it is $33.13, and for 2016 it is $34.10. This is then multiplied by the total # of months you were eligible for Part D coverage but didn’t join. The result is your monthly penalty and once the penalty is imposed it never goes away.

What if I don’t take any prescription drugs right now?

It still may be a good idea to purchase a PDP even if you get the lowest cost package available and hold on to it. You really never know when you suddenly may need to start taking prescription drugs.

How do I get a Medicare Prescription Drug Plan coverage?

You must enroll with one of the private insurers that offer PDP or Medicare Advantage plans that includes prescription drugs. There are several different enrollment methods such as finding a local insurance broker that has the experience to evaluate your specific needs. This alone could save you hundreds if not thousands of dollars each year.

What can I expect for a premium?

Each plan sets its own premiums for each calendar year. This is why it is wise to find an experienced insurance broker that can help you find a plan that most suits your needs.

Can my income affect how much I’ll pay?

Yes! It very well could. Prescription Drug Plan members who make over a certain amount of income each year are charged an Income Related Monthly Adjustment Amount (IRMAA) on top of their plan premiums. You only are only required to pay this adjusted amount if your modified adjusted gross income (MAGI) from your latest tax return, is more than $85,000 (for an individual) or $170,000 (for a couple filing joint tax returns).

Does everyone get the same coverage?

Each Medicare Prescription Drug Plan must offer a minimum level of coverage specified by law. But some offer better benefits, lower costs, and have a different infrastructure. Different is better sometimes depending on your needs. Keep in mind, plans change from year to year.

How many plan choices do I have?

There literally are dozens of different plans available no matter what State you live in.

Why does the same PDP charge different copays for different drugs?

Most Prescription Drug Plans arrange their charges in Tiers Levels.

Example:

  • Tier 1 is for Preferred Generics,
  • Tier 2 is for Generics
  • Tier 3 is for Preferred Brand names
  • Tier 4 is Non Preferred Brand drugs
  • Tier 5 is Specialty Drugs, depending on the Plan. Some plans use more than four tiers and while others choose to use less.

What if I still can’t afford the costs?

“Extra Help,” is a Medicare Drug Program specifically design for this reason. It provides continuous drug coverage at low costs for people with limited income and savings. Some State Pharmacy Assistance programs offer a similar programs. If you cannot afford your prescriptions we can refer you to programs that may be able to assist you.

How Can I Learn More?

National Insurance Services of North America wants to make sure you get the coverage you need! Medicare provides information every year in the Fall to help you get ready including information on how to choose and join a plan that most suits your needs. In your Medicare & You 2016 handbook, is a detailed list of the Medicare Prescription Drug Plans (PDP) available in your area.

Medicare makes available several places where you can find more information about Medicare Prescription Drug Plans, or you can call us and we will be happy to assist you in finding a plan that most suits your needs.

Call us at 1-800-564-7662 Monday through Friday from 8am till 6:30pm.
Or contact the:
Social Security Administration
1-800-772-1213
TTY users should call
1-800-325-0778

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