Private insurers contract with the federal Medicare program to offer limited insurance coverage of prescription drugs for qualifying elderly and disabled persons. This is known as Medicare Part D.
For Medicare to Pay Your Prescription You Will Need to First Pay:
Monthly Premiums
For Medicare recipients who elect to participate in Part D, they will pay a monthly premium (currently averaging $30).
An Annual Deductible
In addition to the monthly premium you will also be required to first meet a specified deductible (which in 2021 cannot be more than $445).
Co-Payment
For each prescription, you still must make a co-payment (typically 20-25%). Due to the Affordable Care Act, in 2021, until your total out-of-pocket spending reaches $6550, you pay 25% for both brand name and generic drugs. Once your total out-of-pocket spending exceeds $6550, you reach what they refer to as “catastrophic” coverage. At this point, you only pay a small co-payment, the amount of which is determined by the type of drugs you take.
Keep in mind that only payments for drugs that are covered by your particular policy count towards the out-of-pocket threshold. If your employer or another insurance policy contributes towards these expenses, that too does not count toward your threshold. Any prescription drugs received from other countries, like Canadian pharmacies, will not be covered by Medicare nor count towards your threshold.
Before choosing a policy, it is important to know what prescription drugs you need and compare those specific drugs between policies. The same drug may vary in price from one plan to another. A comparison tool is available on Medicare’s website.
Anyone who has either Part A or Part B can enroll in Part D; however, Part D does not cover medications that could have been paid through Part A or Part B. Again, doing your research on the specific prescription drug is imperative to getting the right Medicare coverage. During your Initial Enrollment Period (IEP) contact the company offering the plan you selected as the one that best fits your needs and complete an online application. Do so in a timely manner to avoid late enrollment penalties.
For more information on services for the elderly including long-term care planning, estate planning and retirement planning, contact the knowledgeable attorneys at Stouffer Legal in the Greater Baltimore area. You can schedule an appointment by calling us at (443) 470-3599 or emailing us at office@stoufferlegal.com.
