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 2019

  • SilverScript Choice
  • Wellcare Classic

Basic Plan for the Average Person

  • Monthly premiums average $32.50 per month
  • Annual deductible is $415.00
  • Co-pays for prescriptions is 25% up until $3,850 has been paid out of pocket
  • “Donut Hole” – is a gap in prescription coverage
    • Coverage for drugs stops at $3,850
    • Beneficiary is responsible for 100% of drug costs from $3,850 until $5,100 out of pocket
    • Once the annual cost of drugs reaches $5,100, 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

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 fo 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.
  • 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 $85,000 per year and couples with income greater than $170,000 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

How to choose a Medicare Part D Plan

  • 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