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What Costs to Expect with Medicare Prescription Drug Coverage

 

What Costs to Expect with Medicare Prescription Drug Coverage

 

Some people who are eligible for Medicare benefits choose Original Medicare(Medicare Parts A and B) and then add a Medicare Prescription Drug Plan(Medicare Part D) from an insurance company or other private company. Others choose to receive their Medicare benefits through a Medicare Advantage Plan(Medicare Part C) that can or already does include Medicare Part D prescription drug coverage.

In both cases, the types of costs you can expect to pay for Medicare prescription drug coverage are similar.

 

You usually pay a monthly premium for coverage

 

  • If you have Original Medicare, you can arrange to have the monthly premium deducted from your Social Security check.
  • If you have a Medicare Advantage Prescription Drug Plan (MAPD) that has a monthly premium, you typically receive a bill from the private company that provides your plan. Or, you can arrange to have the monthly premium deducted from your Social Security check.
  • If you have a Medicare Prescription Drug Plan (PDP) alone (without Medicare Advantage) and it has a monthly premium, you typically receive a bill from the private company that provides your plan. Or, you can arrange to have the monthly premium deducted from your Social Security check.

 

There may also be a yearly deductible for your prescription drug coverage

 

If there is an annual deductible, you will need to pay this amount each year before the plan starts paying for its portion of the costs for covered medications.

  • There are limits on how much the yearly deductible can be.
  • Some plans do not have a yearly deductible, however, the monthly premium for these plans may be a little higher.
  • If you qualify for the federal Extra Help program you may not have to pay the full deductible.

 

There may be copayments or coinsurance for your medications.

 

  • With copayments, you may have to pay a set amount for a medication. For example, you might pay $5 at the pharmacy for a generic drug.
  • With coinsurance, the plan may pay a percentage of the cost, and you will have to pay the remainder. For example, your plan may pay 90 percent of the cost of a generic drug, and you might have to pay 10 percent.

 

Nearly all plans have different rules for how much you pay for different types of medications.

 

  • Covered generic drugs may have a very modest copay. For example, you may have to pay $5 for each prescription.
  • BCBSGA drugs may have a larger copay than generic drugs.
  • Specialty drugs typically have the highest out-of-pocket cost. For example, for each prescription you might pay 33% of the pharmacy charge or you might be responsible for a very high copay.
  • These different types of payment amounts fall into levels called "tiers." Some companies use three tiers, while others have up to six tiers. Your plan provider will share information about the plan's tiers with you.

 

Coverage Gap

 

Medicare prescription drug coverage also has something called a coverage gap.

  • In a calendar year, there is a limit on coverage after you and your Medicare Part D Plan have spent a certain amount.
  • If you hit this limit because the amount of medications you are prescribed, you may be required to pay for the whole cost of your medication during the coverage gap stage. The good news is you will pay for these medications at a discounted amount.
  • Once your spending reaches what is called a "catastrophic" amount, the plan begins covering drugs again. In the post-gap catastrophic stage, you will pay a small copay or coinsurance. When the new year begins, the initial coverage stage or your deductible stage will start over.
  • Some plans provide extra coverage to help cover some costs when you are in the coverage gap.The monthly premiums for this type of plan are usually higher.

There is a lot more you will want to learn about Medicare prescription drug coverage.

Learn which BCBSGA plans are available in your area and compare your options. BCBSGA has online tools to help you decide the best medical coverage plan and prescription drug plans for your needs and your budget.

Sources:

www.medicare.gov

The Medicare & You Handbook


Y0071_14_18421_U CMS Accepted 10/06/2013
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Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., is an HMO with a Medicare contract. Enrollment in Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. depends on contract renewal.
Blue Cross and Blue Shield of Georgia, Inc. is an LPPO plan and a PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of Georgia, Inc. depends on contract renewal.

Blue Cross and Blue Shield of Georgia, Inc., and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Anthem Insurance Companies Inc. (AICI) has contracted with the Centers for Medicare & Medicaid Services (CMS) to offer Medicare Prescription Drug Plans (PDPs) noted above or herein AICI is the state-licensed, risk-bearing entity offering these plans. AICI has retained the services of its related companies and authorized agents/brokers/producers to provide administrative services and/or to make the PDPs available in this region.

Blue Cross and Blue Shield of Georgia, Inc. and AICI are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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