Part D Rx Prescriptions
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.
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.
The Annual Open Enrollment (AEP) is from October 15th to December 7 and then your coverage will begin January 1 (Medicare FAQ.)
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BE CAREFUL OF THE SNAFU’S!!!
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 *
See the links in the footnotes and brochures in the “margins”
InsureMeKevin.com on figuring all this out, even with mandatory agent training Rev 8.2015
Publication # 11135 When Can You Join a Medicare Drug Plan?
Part D Extra Help #10525
Understanding Part D Extra Help # 10508
MTM Medication Therapy Management Programs for Complex Health Needs – Humana MTM program elements include:
- Comprehensive reviews of medications used on an annual basis;
- Quarterly medication reviews;
- Identification of medication related problems;
- Prescriber and beneficiary interventions to promote coordinated care; and
- Standardized action plans and summaries.
medicare.gov Part D Index
More FAQ’s Medicare Site
- Q1 – competitorCMS – Credible Coverage Rx Plans Medicare Rx Drug Manual Chapter 14 – Co Ordination of BenefitsWikipedia.org/Cornel Law – Part D
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
Subpart 2—Prescription Drug Plans; PDP Sponsors; Financing
Subpart 3—Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans
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.
Child & Related Pages – Site Map
- Blue Cross Rx
- Blue Shield Rx
- Donut Hole – Coverage Gap
- Maximus Appeals LEP Late Enrollment Penalty
- Premiums for those with High Income Parts D Rx & B Doctor Visits
- Shop & Compare Tools Part D Rx
- UHC – Part D Rx