Medicare Explained - Part D (2023)

…If you were researching Medicare and want to learn more about Medicare Part D prescription drug plans, this is the video to watch. This video includes the Part D changes that became law with the Inflation Reduction Act of 2022. I'll also discuss what may happen with those changes before some of them go into effect. Since I would like you to fast forward to any specific section of this video, I have created a menu link to the video description below. Use that menu link and click where you want to go. And I'm also showing you on one side or another here that menu.

Now, in case you're watching this on TV, I often watch my YouTube on TV and you don't have access to what's underneath. So if you're new to Medicare or just want to better understand your Part D benefits, this video has the information you'll need. So stay tuned... Hi, I'm Matthew Clawson from Medigap seminars.org. We are an independent insurance broker helping people with their Medicare and retirement needs in 49 states, from Hawaii to Virginia and Alaska to the Florida Keys. We are true independent insurance brokers and that means we work with all major insurance companies. We offer all Medicare Supplement plans.

We offer Medicare Advantage plans. And of course, who are the very popular

part

D website shopper.com. Prescription drug plans, but above all we represent your best interests. Not those of any insurance company and our services are free to you. Check out our five-star ratings and then contact us. You'll be glad you did. So let's get started and we'll start with something that's very important to understand. There are four different ways you can be prescribed a medication, how your medication is cured. and administered will determine which

part

of Medicare is responsible for payment. And keep this in mind, how you are prescribed and administered the medication is more important than what medication you are receiving...

So, first there are inpatient prescriptions. If you have ever been admitted to a hospital, you may have noticed that you are not allowed to bring your own medications, such as blood pressure pills or statins, etc. And that's because the hospital must control your medications for your safety and responsibility. All medications of any type given to you as an inpatient in a medical facility will be covered under Medicare Part A. And your supplement if you have it. If you have a Medicare Advantage plan, you will be covered under the terms of that particular annual contract. Second are the drugs covered by Medicare Part B. coverage.

As a general rule, if your medication is administered by a medical professional in a medical facility, it should be covered by your Medicare Part B outpatient insurance and its supplement, if you have one. Now, this can include infusions or injections. Medicare Part B generally covers medications for your durable medical equipment, such as a nebulizer or infusion pump. All of that should be in part B. Oral cancer medications may be covered. And this includes oral anti-nausea medications used as part of a chemotherapy regimen. If used as a replacement for intravenous anti-nausea medications and taken within 48 hours of chemotherapy.

There are some medications that are self-administered in an outpatient hospital setting that are also covered under Part B. And under certain conditions, Medicare Part B will even cover injectable osteoporosis medications. Third are the prescriptions. medications covered by Medicare Part D, which is what we're talking about today. In general, any prescription medications that you pick up at a pharmacy or by mail after your doctor has written a script for you? It would be covered by your Medicare Part D plan. These are prescriptions that you administer yourself at home or outside of a medical professional's office. And these are the prescriptions that Medicare Part D was designed to handle.

Also included in Part D, Medicare prescription drugs are biologics, insulin, and other diabetic medical supplies associated with insulin and some vaccines. There is also a hybrid option for receiving and managing your prescription that is covered by your Part D prescription drug plan. And this hybrid is called brown bag or white bag for your prescriptions. They usually involve the use of a specialized pharmacy. The brown bag is when the pharmacy gives you the product. to you or pick it up at the pharmacy. And then you take that prescription to the doctor's office to have it administered by a professional.

White bagging is when the pharmacy delivers the patient's prescription directly to the doctor's office. And then a medical professional administered the prescription to the patient. White bags are often used when the medication is temperature sensitive and needs maintenance and monitoring. So brown bags and white bags or growing trends in healthcare because they take prescriptions that normally would have been covered by Medicare Part B in your outpatient services and shift the burden of cost sharing to your prescription drug plan. Part D... Doing so relieves the financial pressure placed on a doctor's office to purchase and stock these medications that... can cost thousands of dollars.

Therefore, although it is a growing trend, it is reserved for very expensive special offers. medications such as some chemotherapies. So how does Medicare Part D work? How is it structured? It is important to know that all Medicare Part D prescription drug plans and as of December 31 of each year, are one calendar year plans. If you start a plan in January. Ends December 31. If you start a plan in September, it ends on December 31. Every time you get a plan, you are making a commitment to the insurance company and the benefits promised in the policy. Or simply until December 31.

The second thing to understand about Medicare Part D plans is that each plan is different. Each has a different formulary of covered medications. In fact, most insurance companies have two or three different Part D plans designed for people in different situations. form by the way. It is the list of medications. covered by that plan? And Medicare Part D plans are regulated by the government. But not standardized. Each plan is different. On covered prescription drugs. And the cost for the consumer. However…each Medicare drug plan must meet a certain minimum benefit level. Part D drug coverage must include a minimum of two prescription drugs per category.

Plus virtually all available medications in six protected categories. Therefore, the intention is to have broad drug coverage available in each plan. So that the consumer is never in the position of needing a prescription and not having that drug or a similar drug available… The six protected categories where the part D plan must cover substantially all drugs available for treatment. Include immunosuppressants... Antidepressants, antipsychotics, anticonvulsants. Antiretrovirals and anti-plastics Neo your drugs against cancer. And I mentioned earlier that each Medicare prescription drug plan has its own formulary or drug list. The form is divided into tiers based on their cost to you.

The consumer. Most plans have five levels divided as follows. Tier one includes the most common generic medications. These may have no co-pay, and if there is no co-pay, there will be no cost to you. Tier two may include some generic drugs and possibly some common brand name drugs. Tier two drugs may have a small copay. And often we don't have copays. And tier three has a higher copay and typically includes brand-name prescriptions that are on the preferred list. According to the insurance company's contract with the manufacturer, it is broken. and five are usually specialty levels. The consumer's responsibility will be coinsurance of a percentage of the cost.

These are the highest costs and the specific medications that are prescribed less frequently. It is important to remember that a plant's drug-free status can change each calendar year. Each prescription drug plan has slightly different benefits, but often certain drug tiers will have no co-pay requirements. Which means that the consumer will have no out-of-pocket costs. For example, some Part D plans may state that all tier one and two drugs are exempt from the deductible. And not have a co-payment. Some plans' drug formularies are weighted toward lower-tier drugs, while other drug plan formularies may favor higher-tier drugs. And this brings us to a very important and very common misconception about Medicare prescription drug plans.

And that's the bonus. It is related to the value of the plan. A low premium plan does not offer less coverage than a high premium plan. All covered drugs in all categories, in addition to substantially all drugs in protected categories. People usually believe. If they get a higher premium plan. It will provide more benefits. In general, this is not the case. A higher premium plan is designed for people with high prescription drug costs. A low premium plan is generally designed for people with few or no prescriptions. Now I'll get into that in a little more detail later.

Below we will cover the four stages of Part D. Standard Medicare prescription drug plans are structured so that there are four stages. And this is where some of the new rules will improve the plans. The first stage consists of the plan's deductible. The deductible is an amount you must pay for your pre-covered drugs. your insurance plan pays any benefits. The maximum deductible is set each year by Medicare. Insurance companies may set a lower deductible. But no more than the maximum set by Medicare. For

2023

the maximum deductible is $505. And if you're watching this video after

2023

, I have a graphical link below that will detail the current year numbers that Medicare sets annually.

If you don't have any recipes or have many recipes, you can skip the next part. And simply use the menu in the description to advance the video. the new Part D drug rules starting in 2023 or Medicare Advantage plans versus standalone Part D or any of the other menu items. For those who spend a lot on recipes, we'll cover you here. The other three stages. Thus, during the second stage the consumer in the insurance companies. shares the cost of the medication. The consumer pays 25%. The insurance company pays 75%. This continues until you reach a coverage limit of 4000, $660. Now keep in mind the 25% 75% rule.

It may be what is called an actuarial equivalent, that is, an average and not exact for each prescription. Once your insurance company has shelled out $4,660, it will no longer participate in your prescriptions. And that's when your plan moves to stage three. And when the third stage of the pharmaceutical manufacturer picks up where its insurance company left off. You still pay 25% of the cost of covered drugs. Then 70% is paid by the pharmaceutical manufacturer and 5% by Medicare. Now, this stage is often called the coverage gap or coverage gap. It is no longer a coverage gap. Anyway when your expenses plus that 70% that the manufacturers pay reach $7,400.

The pharmaceutical manufacturer steps aside. That's it. And its part D advances towards the final phase four. It is estimated that at the end of the third stage, a typical consumer will have approximately $3,100 out of pocket. The rest is paid by the insurance plan, the manufacturer, and Medicare. So this is where the new law will have a big impact. Starting in 2025, there will be a cap on consumers' out-of-pocket costs for prescription drugs of just $2,000. This fourth stage is called catastrophic coverage and in this stage by 2023, Medicare pays 95% of brand name drug costs. Virgin. You may pay a small copay of between $4 and 15 cents and $10 and 35 cents.

But Medicare pays most of your prescription drug costs. Therefore, by 2023, Medicare pays 95%. You will pay 5% and there is no maximum disbursement. So there is a big change here too and this starts in 2024. Starting in 2024. There is no more 5% consumer paid in stage four... and one-time catastrophic coverage. Once the consumer reaches stage four, Medicare covers one hundred percent of the drug costs. Now we are ready to understand the difference in Part D premiums that I mentioned and I will come back to earlier. So, let's get back to the difference between a low-premium Part D plan and a high-premium Part D plan.

High premium plans are designed to get people into catastrophic coverage as quickly as possible. So that doctor. pays 95% of drug costs. By 2023 and then one hundred percent from 2024. This is where we cover thedifferent elements found in the inflation reduction law of 2022. Let's look at some other changes to keep in mind that were approved. And as part of the inflation reduction law. So, firstly, more people will be eligible for low-income subsidies. In 2022, a person earning 135% of the poverty level or more will not be able to receive low-income subsidies. Called L I S beginning in 2024. L I S subsidies are available to people earning 150% of the poverty level or less.

Therefore, it is estimated that 400,000 more people will qualify for financial aid. And there are the costs of insulin. We will have a limit of $35 per month starting in 2020, no matter how you receive your insulin. We mentioned the $2,000 out-of-pocket limit in 2025. And we already mentioned that Medicare will cover one hundred percent of drug costs during stage four of catastrophic coverage. In 2026, Medicare will be able to negotiate prices for some drugs. The number of drugs eligible for negotiation will increase by three each year until 2029. And then there is the cost sharing of war. Vaccines for adults will be phased out and many vaccines will be free starting in 2023.

This is now estimated to affect more than 4.1 million people. Please note that these benefits were created by the benefits program approved by the previous administration. It was delayed from a start in 2023. To a start in 2032. So I like these Bennetts. and the changes we just reviewed. But in Washington DC nothing is set in stone. Whether these changes have a big impact on Medicare costs. Another administration could unite them to keep Medicare solvent. So I will be on the lookout for how these new rules affect Medicare and how the law has unintended consequences. You can force other changes.

Remember there was nothing in this bill that I know of? This is where this money will come from. But if you are subscribed to my Facebook page, the Medigap Seminars Facebook page. Not my personal one. Medigap seminars or my YouTube channel. You will receive these updates as soon as I can report them. And it should show you here on this screen. The link to my Facebook page and of course the YouTube channel which you should already be watching. And if not, just go to the Medigap seminars on YouTube. I'm sorry. We looked at the two different ways you can get a Part D plan.

But before we do, I'd like to ask you to hit the Like button below. If you're watching this on YouTube, there's a Like button below that you can press. And let me know in the comments if you find this information useful. When you like to comment or share this video you are helping me by letting YouTube know that this is a video worth watching. That way, other people like you who also have questions about their D part will be able to find this video. We now know how to know when a prescription drug should be covered under Part D.

We also know the cost, stages, and stages of the day. So now let's look at the two different ways you can get your due date. You can get Part D either along with a Medicare Advantage plan or as a stand-alone prescription drug plan. And then work with your original Medicare. So let's look at the Medicare advantage. plans first. And again, if you are not interested in this section, you can use the menu links to go forward or back. Medicare Advantage Plans vs. Stand-alone Partial Date, Most Medicare Advantage plans, not all, but most Medicare Advantage plans come with a Medicare Prescription Drug Plan package.

Now, this drug coverage is simply a bundled Medicare Part D plan. These advantage plans are known as Medicare prescription drug advantage plans. You can see M to P D in the…Identifier. Not all plans with Medicare benefits. Offer drug coverage again and that's going to be important because if you have a Medicare advantage, HMO or PPO, you can't get a stand-alone plan. So let's go over that a little more here in a second. Those that do not offer a prescription drug plan are simply called Medicare Advantage plans are M Ma... now most Medicare Advantage plans are designed, for example, for veterans who use the VA benefit for their creditable prescription drug coverage.

With a MAPD plan, you may still have to pay a separate monthly premium and a deductible, if applicable, for your prescription drugs. And it is also essential to understand that any out-of-pocket maximum declared by the benefit plan. It does not count toward your prescription medications. They are separated. And what is the weakness of this new agreement is that it can be difficult to find a Medicare Advantage prescription drug plan that has its doctors in-network and also has a fair price for its prescription drugs. With a Medicare Advantage plan. If you want to buy your prescription medications at the best price, you may have to sacrifice some of your primary healthcare benefits.

Or even changed doctors. Remember that the benefits and network of your Medicare prescription drug plan and Medicare Advantage plan may change each calendar year. This is very important. There is a special rule about HMOs with Medicare advantages in PPS. And Medicare drug plans. So if you have a Medicare Advantage plan that is an HMO or a PPO. You also cannot have a separate, independent Medicare drug plan. If you buy a stand-alone Medicare prescription drug plan, when you have a Medicare Advantage HMO or PPO, whether it offers prescriptions or not. Medicare will cancel your HMO or PPO.

It doesn't matter whether your HMO or PPO has bundled drug coverage or not. You can't have both. A stand-alone Part D and a Medicare Advantage HMO or PPO. In contrast, if you have a stand-alone Part D drug plan and then apply for a Medicare HMO or PPO. Your Medicare drug plan will be canceled. Finally, be careful when signing up for a Part D or Advantage plan. If you have Lifetime Tri-Care or VA Champion. So check out my video on how Medicare works with Tri-Care for life. It's probably linked here somewhere and also below. Most Part D plans offer cost savings through a number of network pharmacies...preferred network pharmacies will offer prescriptions at a lower price than standard out-of-network pharmacies .

There may also be pharmacies that do not accept your insurance, but the plan's preferred network may include small local pharmacies as well as a large national pharmacy chain. Preferred pharmacies contract with the insurer and offer lower prices negotiated by the insurance company. Additionally, there is usually the option of receiving regular prescriptions through a mail-order pharmacy. Therefore, using a network pharmacy is essential. To keep your prescription drug costs down. You really want to be aware of which pharmacies are in network and which are not, every year we get calls from people who are shocked by the cost of a medication.

It's not like what. It seemed to be when they bought it. And most of the time he. The problem was that they were going to an out-of-network pharmacy. Therefore, Medicare Part D beneficiaries should consider the pharmacy network when selecting Medicare prescription drug plans. So, below we will answer the question: when can you apply for part D? You can apply for Medicare Part D as long as you are eligible for Medicare Part A. You do not need to have Medicare Part B to apply for your Part D prescription drug coverage. This way, if you delay enrolling in Medicare Part B because you have credible employer coverage, you can enroll in Part D whether that will improve your prescription drug coverage.

However, you will need a Medicare beneficiary number which you will get when you enroll in part a. Most people apply for Part D coverage during the initial enrollment period. That's the seven-month window around the month you turn 65. I have an initial enrollment period calculator on my website. To help you find your enrollment period. I have a link down here. If you are using your initial enrollment period, the earliest you can start your Part D coverage is the first day of the month in which you turn 65. The exception to this is when your birthday falls on the first day of the month.

In that case, your entire initial enrollment period is moved forward one month. If you do not enroll in Part D during the initial enrollment period, you can apply during the annual enrollment period. From October 15 to December 7. The general enrollment period which is the first quarter of the year. Or a special enrollment period. And basically, if you didn't make your initial registration, give us a call so we can discuss your options. We'll help you get back on track. So how do you buy a partial appointment? I created a website to help customers learn more about Part D and purchase a plan.

It includes a link to a plan shopping and enrollment tool that will show you which of the Medicare Part D plans I recommend. The website is called part D shopper.com. Now keep in mind that this site only shows the plans and companies that I recommend. These companies represent approximately 85% of all Part D plans in the United States. And if you want to see all the plans that are available to you if you don't like the ones I show you. You can use a similar but less consumer-friendly tool on the

medicare

.gov website. There you have it.

Now is your turn. I make these videos for you and I make them to help you make an informed decision. So leave me a comment below. And let me know which part of this video you found most informative. And if you have any questions I didn't answer, ask them below. I will do my best to answer it. I hope this information has been useful to you, like this video. Press the thumbs up for me. And if you found this information helpful, please share it with others so they know what to do with their share too, Dave.

I'm Matthew Clawson from Medigap seminars.org. Thanks for watching …