Medicare
Part D Rx Prescriptions
Part D Rx
Introduction
Part D Rx is practically mandatory. If you don’t have coverage when you are supposed to your premium is increased 12%/year when you eventually do.
Many Part D plans cover the gap or donut hole, just be sure to read the illustrations, brochures, Medicare Guide to Rx and drug formularies, on or through our website.
Medicare Advantage plans generally include prescription drug coverage, including both brand-name and generic at participating pharmacies in your area.
Check out our webpages for more details, coverage and premiums.
- Part D Rx Prescriptions
- Anthem MediBlue Rx Part D
- UHC United Health Care – Part D Rx
- Blue Shield Rx Part D
- Shop & Compare Tools Part D Rx
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- You can get a table or listing of each company’s Part D premiums, copays, deductibles I can look at for comparison?
- High Income Surcharge IRMAA Parts D Rx & B Doctor Visits
- Part D Rx Late Enrollment LEP Penalty Appeals
- Part D Rx Low Income Subsidy – LIS – Extra Help
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- Medicare.Gov Plan Finder for 2025
- Do not enroll on the Governments site, send us your results and we can enroll you
- Scroll down for FAQ's, instructions and how we can help you navigate Medicare. It's better to create an account and log in. That way your Rx gets saved and/or automatically listed.
Here's the webpages for the Part D Rx plans we are agents for.
How to use the Rx & Plan Finder
- How to Create a My Medicare.Gov Account
- That way your Prescriptions Rx are automatically populated
- Our email is encrypted sending & receiving by Paubox.com
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- Our Webpages for more detail...
BE CAREFUL OF THE #SNAFUS !!!
- Medicare Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month
- WellCare complaints - Pro & Con
- But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit/hyperactivity disorder, her pharmacist told her she owed $275.90
- “The [Medicare] Plan Finder is an outside source and therefore not reliable information,”
- We strongly urge that you use the "print" feature on Medicare.Gov and save your work! Also, check the website of the Insurance Company you want to use.
- Here's video instructions on how to use the print button 3 minute version 30 second version
- Here's video instructions on how to use the print button 3 minute version 30 second version
- We strongly urge that you use the "print" feature on Medicare.Gov and save your work! Also, check the website of the Insurance Company you want to use.
- The “Total Yearly Cost of Care” does not provide personalized or transparent information. For example, when a consumer inputs or changes personal data, such as drug information, his or her total estimated costs do not change. This is not mathematically possible based on the plan benefits. Additionally, the tool does not share what is included in the total cost. As a result consumers will likely see the total cost and assume they are receiving a personalized and tailored estimate which may not be accurate.
- The estimated total yearly cost of care is flawed. On a plan that has reduced benefits year over year, the expectation would be that the “estimated total yearly costs” would increase. However the tool is inaccurately estimating the consumer’s costs will decrease. It doesn’t make mathematical sense. For consumers on a fixed income and cost conscious, this could be detrimental to their situation.
- Most supplemental benefits are not included in the total yearly cost of care. Over the past several years supplemental benefits have expanded and provided members with options that not only treat, but prevent illness and increase quality of life. We know the high value of benefits such as vision, dental and hearing to our consumers, and they are a key way we are partners in care with our members. Some of the benefits that are not included are:
- Transportation lists copay but not number of rides.
- Eyeglasses list copay but does not share if benefit covers frames, lenses or contacts.
- Wellness Programs include a long list of possible items including fitness, nurse hotline, Personal Emergency Response and telehealth, that can’t be lumped into a single “covered” or “not covered” benefit. Excerpt from UHC Agent Memo * Forbes * GAO 7.2019 Report *
- No charge - Medication Review
Try turning your phone sideways to see the graphs & pdf's?
Prescription Drug 2025 #RxGuide
PDF # 11109
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Coverage Gap - Donut Hole $2,000 Cap
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- Medicare Part D Rx generally runs say $30 to $100. See link below for how to shop premiums.
- Scope of appointment - permission to discuss Rx and MAPD Plans
- Our Webpage Premiums for those with High Income Parts D Rx & B Doctor Visits
- Medicare Rules for High Income People Medicare Costs # 11579
- Our #High Income Surcharge Video Explanation
- Ways to pay your premium - See brochure above.
- Kaiser Foundation Introduction - Overview
- Fact Sheet Medicare Part D CA Health Care Advocates Hi Cap
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. Prescription Drugs Hi Cap
- Medicare Part D: An Overview – 10-31-23
- Prescription Drug Resources – 11-07-22
- When Your Part D Prescription is Denied– 11-22-22
- Medicare Rx Benefit Manual Rev 1.2016 83 pages
- Resources: Medicare Drug Coverage (Part D) Mini-Course & Podcast Series CMS
- Network Pharmacies, Formularies & Common Coverage Rules # 11136
- Insulin Maximum Co Pay $35
- Graphic on Part D Premium Increases & Why?
- Maximus Appeals LEP Late Enrollment Penalty
- Shop & Compare Tools Part D Rx
- Get Instant Quotes, Information & Enroll online
- MANDATED wording!: ‘‘We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.’’ § 422.2267(e)(41).
- We disagree with the above wording, as we can use the same tools on Medicare.gov as they do!
Research & Technical Resources
- Q1 – competitor
- CMS – Credible Coverage Rx Plans Medicare Rx Drug Manual Chapter 14 – Co Ordination of Benefits
- Wikipedia.org/
Medicare Prescription Drug, Improvement and Modernization Act of 2003 416 Page pdf gpo.gov
2017 Announcements 250 pages
Part D—Voluntary Prescription Drug Benefit Program
Subpart 1—Part D Eligible Individuals and Prescription Drug Benefits
Sec. 1860D-1. Eligibility, enrollment, and information
Sec. 1860D-2. Prescription drug benefits
Sec. 1860D-3. Access to a choice of qualified prescription drug coverage
Sec. 1860D-4. Beneficiary protections for qualified prescription drug coverage
Subpart 2—Prescription Drug Plans; PDP Sponsors; Financing
Sec. 1860D-11. PDP regions; submission of bids; plan approval
Sec. 1860D-12. Requirements for and contracts with prescription drug plan (PDP) sponsors
Sec. 1860D-13. Premiums; late enrollment penalty
Sec. 1860D-14. Premium and cost-sharing subsidies for low-income individuals
Sec. 1860D-14A. Medicare coverage gap discount program
Sec. 1860D-15. Subsidies for Part D eligible individuals for qualified prescription drug coverage
Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans
Sec. 1860D-21. Application to medicare advantage program and related managed care programs
Sec. 1860D-22. Special rules for employer-sponsored programs
Sec. 1860D-23. State pharmaceutical assistance programs
Sec. 1860D-24. Coordination requirements for plans providing prescription drug coverage
Prescription Drug Coverage – General Information
Click the selection that best matches your area of interest. Please check back, as we will continue to update these resources regularly.
Consumer Resources
- CA Health Care Advocates on Part D
- Medicare.gov/Part-D
- cal medicare.org
- Wiki Pedia
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How Medicare Drug Plans Use Pharmacies,
Formularies,
and Common Coverage Rules
Things to Think about when You Compare Medicare Drug Coverage cms.gov
Comprehensive Addiction and Recovery Act (CARA)
- Veteran’s Information
- InsureMeKevin.com on figuring all this out, even with mandatory agent training Rev 8.2015
https://www.reuters.com/business/healthcare-pharmaceuticals/us-medicare-says-part-d-advantage-premiums-will-fall-2025-2024-09-27/
I know that if I get a Medi Gap plan, I can buy Part D Rx and that if I get a Medicare Advantage with Part D MA-PD I can’t get extra coverage to cover Rx, what are the other restrictions on what plans go with Part D and which ones don’t?
Yeah, it’s a confusing question as so much of the questions and plans do not apply to California, but yet when we do our AHIP annual certification, they ask a ton of questions on it. IMHO especially annoying is the AHIP material doesn’t give citations and isn’t “official” plus it’s copyrighted… and password protected. I wish they training just used Official brochures that we could use with the public.
Section 4: Your Coverage Choices
Get help with drug coverage decisions (of course you can email us [email protected] or leave your question below too) What else do I need to think about before I decide to get Medicare drug coverage?
I have only Part A and/or Part B and no drug coverage I have Medicare and a Medicare Supplement Insurance (Medigap) policy without drug coverage
” Medicare Supplement Insurance (Medigap) policy with drug coverage
” get drug coverage from a current or former employer or union
” Federal Employee Health Benefits (FEHB) plan
” TRICARE or benefits from the Department of Veterans Affairs (VA) that include drug coverage I have a Medicare health plan (MA Medicare Advantage) without drug coverage
I have a Medicare health plan with drug coverage MA PDI have Medicare and Medicaid Medi-Cal
… get Supplemental Security Income (SSI) benefits or belong to a Medicare Savings Program
… and live in a nursing home or other institution
… and benefits through Programs of All-inclusive Care for the Elderly (PACE)
… and get help from my State Pharmacy Assistance Program (SPAP) paying drug costs
I get help from an AIDS Drug Assistance Program (ADAP)
I have Medicare and get drug coverage from the Indian Health Service, Tribe or Tribal Health Organization, or UrbanIndian Health Program
Official Medicare Brochure # 11109 Prescriptions