Basic Part D Benefits
Part D Basic Benefits
Insurance carriers that sell Part D prescription plans must provide benefits that "on average" must be as good as the following chart. These figures are for the 2012 plan year. Read this chart from the bottom up.
Coverage Phase |
Cumulative Total Drug Costs |
Plan Plan's Cost Share |
Member's Cost Share |
Cumulative Member Costs |
|
Catestrophic Phase |
No Maximum |
Plan pays 95% |
Copay or 5% whichever is greater. Generic $2.60 Brand $6.50 |
No maximum out of pocket |
|
Note: If a person takes a mix of brand and generic drugs the cumulative total drug cost will fall somewhere between limits listed below |
||||
|
Coverage Gap (Brand Name Only) |
$6,657.50 for brand only drugs Drug company writes off up to $1,863.75 |
Plan pays $0 for brand drugs |
Member pays 50% for Brand-name drugs. Member pays up to $1,863.75 |
$2,863.25 for brand only drugs |
|
Coverage Gap (Generic Only) |
$7,264.30 for generic only drugs |
Plan pays 14% for generic drugs Plan pays up to $593.78 for generic drugs |
Member pays 86% for generic drugs Member pays up to $3,727.50 |
$4,700 for generic only drugs |
|
Initial Coverage |
$2,930 |
Plan pays 75% ($1,957.50) |
Member pays 25% ($652.50) |
$972.50 |
|
Deductible |
$320 |
Plan pays $0 |
Member pays $320 |
$320 |
Medicare Part D Enrollment
Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.
To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
