Medicare Part D Plan Open Enrollment
Every October 15 through December 7th Medicare Part D plans have Open Enrollment. The programs begin on January 1st.
Medicare Part D is prescription drug coverage with a formulary of prescription drugs, managed by a plan sponsor. If a person participates in Medicare Part A or Part B, then the Part D enrollment is voluntary. If a person has Medicaid, then they must enroll in a Part D plan, or one will automatically be assigned. Medicaid coverage helps with costs of premiums, deductibles and co-pays.
FLORIDA APPROVED PART D PLANS FOR 2020
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SilverScript Choice
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Wellcare Classic
- Cigna Healthspring RX Secure (new for 2020)
- Clear Spring Health Value RX (new for 2020)
Basic Plan for the Average Person
- Monthly premiums average $30.00 per month
- Annual deductible is $435.00
- Co-pays for prescriptions up to 75% of the cost of drugs (depends on the drug)
- “Donut Hole” – is a gap in prescription coverage
- Coverage for drugs stops at $4,020
- Beneficiary is responsible for 100% of drug costs from $4,020 until $6,350 out of pocket
- Once the annual cost of drugs reaches $6,350, Medicare Part D pays 95% of costs
During Open Enrollment Oct – Dec
- Letters will be mailed to all “choosers” regarding their status
- The designated person that choose a plan any year since 2006, will remain the “chooser” and will select a plan for the beneficiary “Once a chooser, always a chooser”
- New beneficiaries can join a Medicare Part D Prescription Plan
- Beneficiaries can switch form on Plan to another
- Beneficiaries can drop their Medicare Part D Plan
How to choose a Medicare Part D Plan
The NEW Medicare Plan Finder is modern, easier than ever to compare coverage and shop for plans
- Use www.medicare.gov web site to determine medications costs, premium costs, and whether medications are covered
- Lowest cost plan may not be best. If the plan has limited coverage of brand name drugs, it will result in higher out of pocket expenses
- Plans should be reviewed annually because both the beneficiary medication needs and the plan formularies change
- Many studies have shown that people stay in a plan to avoid changing, even when it benefits them financially
Medicaid and Medicare Advantage
- Patients that have both Medicare and Medicaid are “Dual Eligible”
- Dual Eligible beneficiaries may request enrollment in a different plan one time during each for the first three quarters of a calendar year
- Dual Eligible beneficiaries have no co-pay or deductible
- Persons enrolled in a Medicare Advantage Plan (HMO or PPO) have prescription drug coverage through these plans
- If a person joins a Medicare Part D drug plan their Medicare Advantage Plan will disenroll them and they will go back to original Medicare
Low Income Subsidy
- For low income people, they may qualify for subsidies to cover co-pays, deductibles and out-of-pocket costs.
- Annual income below $18,735 or $25,365 married and living with spouse for partial benefits. Resources/assets are under $12,890 single or under $25,720 for married couple.
- Those that already have Medicaid or SSI are not eligible for Low Income Subsidy
- Beneficiary should apply at the SSA office or online www.socialsecurity.gov/i1020 or call 800-772-1213
Nursing Home Residents
- Social workers and family members should review coverage annually to make sure resident has coverage for their specific medications
- Nursing home residents can change plans monthly if Dual Eligible
- Nursing home residents can change plans within the first two (2) months of discharge from a nursing home
High Income Beneficiaries
- As of 2019, high income beneficiaries will be charged higher premiums
- High income beneficiaries are persons with income greater than $87,000 per year and couples with income greater than $174,000 per year
- Differences in premiums will be taken from Social Security checks automatically
- Social Security will send a letter to beneficiaries identifying them as High Income
