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Medicare Part D Explained | (And How To Avoid The Donut Hole)

Jun 01, 2021
Medicare Part D is something I get a lot of questions about. It can often be one of the most confusing

part

s of Medicare to understand today. I'm going to break down how Medicare Part D works. We'll talk about the coverage gap. or the coverage gap as well and whether or not that is something you need to worry about so stay tuned hi my name is Stefanie apt. I am an independent insurance broker specializing in helping seniors across the country navigate the world of Medicare. I try to post videos about all the different

part

s of Medicare as well as the Medicare plans and if you find value in the videos I will ask you to take a second and subscribe to the channel you can like the video and make sure you leave your questions in the comments section below.
medicare part d explained and how to avoid the donut hole
I'd love to read them and I'll be sure to respond. Medicare Part D is the part of Medicare that covers your prescription drugs, and you can get your Medicare Part D benefits through a separate Medicare Part D plan. prescription drug plan or through a Medicare Advantage plan that includes prescription drug benefits, either way, the Part D coverage you get will be pretty similar. To talk about how all of that works, we're going to break down the different Medicare Part D coverage phases and how they work, we're going to talk about the coverage gap and whether or not you need to worry about it, and finally we're going to talk about how Find the best Medicare Part D plan to cover your specific drugs and meet your specific needs.
medicare part d explained and how to avoid the donut hole

More Interesting Facts About,

medicare part d explained and how to avoid the donut hole...

All Medicare Part D plans have different coverage phases, so there is a deductible phase. the coverage gap and then there is the catastrophic coverage stage. It's important to know that Medicare Part D plans are calendar-year renewable plans, so each Part D plan renews and restarts. on January 1, including phases, and most Medicare beneficiaries will only get to that first or second phase in any given year when it comes to insurance, the deductible is the amount you must pay out-of-pocket before you insurance kicks in, so for Part D, this means you'll have to pay the full cost of your drugs until you meet the plan's deductible before the Part D plan kicks in in 2020; the standard drug deductible for Part D plans is $435 per year now, some Part D plans have lower deductibles and some have a $0 deductible, but the vast majority of Part D plans Part D has a deductible of approximately four hundred and thirty five dollars in 2020, so the reaction of many people is what is a high deductible.
medicare part d explained and how to avoid the donut hole
I'm not even taking that many medications. I won't even meet that deductible. The good news is that many Part D drug plans even show that they have a $435 drug deductible. ble actually has a zero dollar deductible on its lower-tier generic drugs, like its tier 1 or tier two generic drugs, so if you're taking only tier 1 and tier two drugs, there's a good chance that deductible won't even doesn't even apply to you. If you take a brand name drug or, in most cases, tier 3 or higher, you will have to pay the pharmacy's full cost for that drug before your drug plan takes effect, and remember that deductibles reset along with your plan each January 1 after this deductible phase.
medicare part d explained and how to avoid the donut hole
In the coverage stage comes your Tier Coverage Stage and this is generally the stage you want to stay in, so after you meet your deductible now, when you are in the Tier Coverage Stage, you will only pay a fixed copay or a coinsurance amount set by your drug plan for your specific drugs the amount you pay will depend on the tier your drug is in and the tiers have been set by the drug plan and can vary somewhat from drug plan to drug plan because these tier categorizations can vary a bit between Part B drug plans, we recommend using your drug list to shop each year to find the best Part D plan for your specific drugs and I'll talk about that a little bit more in a little bit after the initial level coverage phase comes the

donut

hole

now there's been a lot of talk about the

donut

hole

being c wrong or the donut hole is supposed to close in 2020 but actually there is still a coverage gap and most people think of that as the donut hole so whether you want to call it the donut hole or donut hole coverage, I'm going to break down what you can expect your drug costs to be if you reach this coverage stage later in the year now. keep in mind that most people will never reach the coverage gap, recent studies have shown that only about 10 percent of Medicare beneficiaries actually reach the coverage gap, or coverage gap. coverage occurs after a certain spend th back to keep the spending limit in dollars can change and in 2020 the spending limit is four thousand and twenty dollars and that is the spending limit that gets you into the coverage gap so that each month when you refill your drugs you go to your pharmacy and you are paying a certain amount for your drugs and the insurance company is paying the rest once the total amount that you and the insurance company have paid together equals four thousand twenty dollars, you've reached that spending limit and now you're in the coverage gap phase of the coverage and when you're in the coverage gap in general, now tend to You will have to pay 25 percent of the cost for your patience and that is taken off the price that your insurance company has set with the pharmacy you use for that drug, say for example you are taking a drug that is at retail price $400 and you're in the initial tier coverage phase paying maybe a forty-five dollar copay for that drug now that you're in the coverage gap, you'll have to pay 25 percent of the costs for that drug, which which equals $100 so now you are paying $100 for this drug where you used to pay $45 so you can see what your drug really costs you can jump when you are in the donut hole the items that count toward getting into the donut hole they are any amount you have paid toward your deductible your copays and your coinsurance for your covered drugs things that do not count toward the coverage gap would be the monthly premium you must pay for your plan of drugs any amount you pay for drugs that are not covered and any amount you would pay for drugs that are completely out-of-network pharmacy now some Medicare beneficiaries will actually leave the coverage gap they may reach the final coverage stage called catastrophic coverage this part gets a little tricky once you've spent six thousand three hundred and fifty dollars As of 2020 you now have catastrophic coverage the reason it gets tricky is that to get catastrophic coverage Medicare only counts the costs that go to your troop, which represents your true out-of-pocket or your total out-of-pocket these are examples of out-of-pocket costs that count toward your troop or your actual out-of-pocket, so these are the costs that will help you get to the catastrophic coverage phase and the amount you paid toward your deductible your copays and coinsurance when you are in your coverage phase to entry level almost the full cost of brand name drugs you bought during the coverage gap but for generic drugs only the amount you paid for drugs in the coverage gap counts not the full cost once all these If your costs add up to $6,350 in 2020, you are now in the Catastrophic Coverage Stage, and in this stage your prescription drug costs typically go down.
In this phase you will only pay 5% of the cost of your drugs or three dollars and sixty cents for generic drugs or $8.95 for brand name drugs, whichever is higher, the coverage gap is pretty bad and no one is happy if it comes over there. It's better than it was in years past, when Medicare Part D was first introduced, you had to pay the full cost of all your drugs when you were in the coverage gap, so how can you

avoid

the coverage gap? ? I am going to share some tips with you. The first and most important tip is to shop your Medicare Part D drug plan every year, as I mentioned earlier in the video, different Part D drug plans may categorize different drugs into different tiers, which in turn you can determine how much you have to pay toward the cost of your drugs, in addition, there are certain Part D drug plans that offer more coverage during the coverage gap than others if you are going to fall into the coverage gap, however, you can It can be hard to

avoid

er there are some plans that can lower your out-of-pocket costs so you definitely want to actively shop for your plan every year and that's something we do as a free service to all of our Medicare Supplement and Medicare Advantage customers and I'm I'm also going to link a video in the description below that shows you how to shop for and find the best Part D drug plan for you. e Medicare on your own using the

medicare

.gov Plan Finder tool.
Another tip is to pay out-of-pocket for some of your drugs if the costs are low enough now if you pay out-of-pocket for your drugs instead of using your Medicare Part D drug plan, those costs won't count toward the expense until the withholding that puts you in the coverage gap, so it's always a good idea to ask your pharmacy how much out of pocket what the price of that drug would be and see if it's equal to or maybe less than the set copay or coinsurance amount by your Part D plan. There are many pharmacies, such as local grocery stores, that offer very low out-of-pocket payments. ices for generic drugs so its always a good idea to check there you can also try using websites like good rx comm to find free coupons for your medications and blink is another resource you can check out and these websites and resources give you coupons free to get pretty big discounts on certain prescription drugs, so if you're taking a lower-tier generic, you can sometimes find that the costs are lower if you pay cash or use one of these coupons than if you use your prescription plan. drugs for that drug and it has to count toward your total out-of-pocket costs to get to the coverage gap Generally, Medicare Part D can be a little tricky depending on the drugs you take, but the good news is that you can change your Part D plan each year that there is an open period.
Enrollment each fall is called the annual Medicare election period where you can change your Part D plan and choose a new Part D plan and that's between October 15 and December 7 if you have more questions about Medicare Part D be sure to check out the links in the video description below and you can always call or email us anytime thanks so much for watching and see you soon

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