Medicare Plans & Coverage: Part A, Part B, Part C, Part D
Medicare is a federal insurance program that covers hospitalization expenses as well as doctor and medical expenses. To be eligible for Medicare, one must be an American citizen 65 years or older, or younger with a qualifying disability.
Medicare Part D Plans, Prescription Drug Plan (PDP)
First Health Part D First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plan(s) depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. This information is available for free in other languages. Please call our customer service number at 1-855-389-9688 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
Medicare Part D coverage gap
In 2006, the first year of operation for Medicare Part D, the donut hole in the defined standard benefit covered a range in true out-of-pocket expenses (TrOOP) costs from $750 to $3,600. (The first $750 of TrOOP comes from a $250 deductible phase, and $500 in the initial coverage limit, in which the Centers for Medicare and Medicaid Services (CMS) covers 75 percent of the next $2,000.) In the first year of operation, there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries, although there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D.
Drug Finder: Find which 2015 Medicare Part D plans best covers your drugs
- Copay / Coinsurance – These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in “tiers”. Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this “Cost Sharing” category:
Medicare Part D Prescription Drug Plans: The Marketplace in 2013 and Key Trends, 2006
For 2013, AARP MedicareRx Preferred PDP (offered by UnitedHealth) is the largest PDP in 22 regions, SilverScript Basic PDP is the largest in 9 regions, Humana Walmart-Preferred PDP leads in 2 regions, and MedicareBlue Rx Standard PDP has the largest share of enrollment in one region. In addition to being the largest plan overall, AARP MedicareRx Preferred PDP has enrolled nearly one-third of all non-LIS enrollees nationally and has the most non-LIS enrollees in 30 of 34 PDP regions (Exhibit 22). With the help of its acquisition strategy, CVS Caremark’s SilverScript Basic PDP dominates the LIS market with about one-third of national LIS enrollment and the highest share of LIS enrollees in 28 regions. Like many PDPs with high LIS enrollment, SilverScript Basic PDP has attracted only a small share (14 percent) of non-LIS enrollees. By contrast, Humana’s Walmart-Preferred PDP has attracted enrollment in nearly equal shares from both non-LIS and LIS beneficiaries, and is among the top five plans by enrollment in each category.
Compare Medicare Advantage & Supplemental Plans
Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.