How Part D works with other insurance

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While prescription drug coverage is an essential health benefit, prescription drug coverage in Marketplace or SHOP plans aren’t required to be at least as good as Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, must determine if their prescription drug coverage is creditable each year and let you know in writing.

2017 Medicare Part D Plans

Medicare Part D plans will change again in 2017. The question for Medicare Part D recipients is – Do the changes to my plan affect me? Part D 2017 was created with expert assistance from the Senior Advisors Group. Our Part D plan website will assist in Part D selection and help seniors navigate the Medicare Part D Drug plans for 2017. After consulting Medicare Insurance specialist with over 25 years of Medicare and Insurance expertise from the Senior Advisors Group, we have assembled several methods for individual to search and get assistance on Medicare Part D and Medicare Supplemental Insurance plans. Our goal is to help seniors find the right Part D plan, and the most cost effective supplemental insurance or Medicare advantage plans.

Medicare Part D coverage gap

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.

Medicare Plans & Coverage: Part A, Part B, Part C, Part D

To be eligible for Medicare, one must be a legal permanent resident for the past five years or a U.S. citizen 65 years or older, or younger with a qualifying disability. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.

Medicare Part D Drug Coverage

Copayments: Once you’ve satisfied the annual deductible, if any, you’ll need to pay 25 percent of the next $3,300 of your prescription costs (i.e., up to $825 out-of-pocket) and your Medicare drug plan will pay 75 percent (i.e., up to $2,475). After that, there’s a coverage gap; you’ll need to pay 100 percent of your prescription costs until you’ve spent an additional $3,725 (some plans offer coverage for this gap). However, once your prescription costs total $7,425 (i.e., your out-of-pocket costs equal $4,950–you’ve paid a $400 deductible + $825 + $3,725 in drug costs, and your Medicare drug plan has paid $2,475), your Medicare drug plan will generally cover 95 percent of any further prescription costs. For the rest of the year, you’ll pay either a coinsurance amount (e.g., five percent of the prescription cost) or a small copayment for each prescription, whichever is greater.

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