Medicare Part D open enrollment starts October 15th (Today!) and continues until December 7th. The Sona team is here to answer your questions and to ensure you choose the best plan for your personal needs!
This year, we are rolling out a new service where you can schedule a free 30 minute individual consultation with a Sona pharmacist (by phone or in person). Please be sure to visit our Facebook page and click the “Book Now” button or visit this link to schedule your personalized appointment.
If you would rather give us a call without an appointment (828-298-3636), or stop by the pharmacy (805 Fairview Road, Asheville NC 28803), we are always happy to help as well!
There are several different types of Medicare Plans and they are described with a letter:
- – Part A is hospital insurance that covers inpatient stays, skilled nursing care, and some home health care. Part A is covered through Medicare taxes and does not have a premium.
- – Part B covers doctor’s office visits, outpatient care, medical supplies, and some preventative services (such as a flu shot!). There is a monthly premium for Part B.
- – Part D covers your prescription medications (think D for Drug). Part D plans can be outright, or grouped into a Medicare Advantage plan. These plans are considered “privatized” and patients have many options to choose from when picking a plan each year.
The costs for Medicare Part D plans vary from plan to plan and can be broken down into five main categories: premium, deductible, copayment/coinsurance, coverage gap, and catastrophic coverage.
The premium is a monthly fee that you pay to be enrolled in a plan. This should be included in your monthly budget when evaluating a plan, because it is an additional cost each month.
The deductible is the amount you must pay each year for your prescriptions before your Part D plan pays its share. This can vary from plan to plan and be between $0 and $415. There are many things to consider when choosing a plan with or without a deductible. For instance, plans with deductibles often create increased expenses at the beginning of the year. Higher deductibles sometimes indicate lower premiums. Lower deductibles may require lower initial out-of-pocket costs.
The copay/coinsurance portion of your medicare plan comes after the deductible is met. If your deductible is $0, you start out the year in the copay phase of your plan. A copay is a set amount that you would pay for a medication in a certain tier (for example: lisinopril may be a tier 1 medication with a $10 copay, while Xarelto may be tier 3 with a $45 copay). With coinsurance, patients pay a percentage of the cost (for example: 25% of the cost is paid by the patient, 75% is paid for the Part D plan). Each plan has different tiers or coinsurances for each medication. Copays can vary widely from plan to plan for the same medication. This is an important place to compare costs across different plans. When a patient satisfies the initial coverage limit he or she will move into the coverage gap, or donut hole. The initial coverage limit is the total retail value of formulary drug purchases (your deductible + copays/coinsurance) that you can make before entering the coverage gap. For 2019, the initial coverage limit is $3,820.
The coverage gap (or “donut hole”) goes into effect after a person meets the initial coverage limit. Not everyone will enter the coverage gap. While a person is in the coverage gap, brand name drugs will be covered at no more than 35% of cost. Generic drugs are covered at no more than 44% of the cost. The coverage gap ends when you spend a total of $5,100 out of pocket during the year. These out of pocket costs include: deductible, coinsurance, copayments, coverage gap payments, and 50% cost of brand name medications that is paid for by drug manufacturers during the coverage gap. Your plan premiums, pharmacy dispensing fees, and any non-covered drugs do not factor into your coverage gap total.
Next is catastrophic coverage. This happens once you spend $5,100 out of pocket and you only pay 5% or $3.40 (whichever is greater) for generics or 5% or $8.50 (whichever is greater) for brand name medications.
To complicate matters even more, these numbers change each year and some patients (for example those with a subsidy) may follow lower standards. This information is the maximum allowed by Medicare for 2019.
One final consideration when picking your Part D plan for 2019 is a plan’s Star Rating. This rating can range from one (lowest) to five stars (highest). These rankings are determined by quality of care, patient safety, drug pricing, and customer service. Medicare assigns a rating for each category, and then assigns one overall star rating.
There is a lot to consider when choosing a Part D plan. Fortunately, patients can make informed decisions by comparing their current situations to plans that will be available in 2019.
Medicare allows us at Sona Pharmacy to provide you objective information that compares plan out of pocket costs throughout the year. This will equip you to make the decision of selecting which insurance plan will best cover your current medications and fit your situation.
As you consider your options, remember that spouses are not required to be on the same plan. In fact, it is often more beneficial for each spouse to choose the best plan for their individual needs.
All Medicare Part D users can make changes to their upcoming plan for January 1, 2019 to December 31st, 2019 beginning October 15th, 2018. Some patients who are dual eligible for both Medicare and Medicaid benefits can change their plan at any time to take effect at the 1st of the following month.
If you do not know if you are dual eligible, please ask us to help you find out!
