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Medicare Part D

from Songer Benefits, Inc.

Medicare Part D Insurance

Part D is a prescription drug plan, provided through several insurance companies in Beckley, West Virginia. Medicare recipients can enroll in a standalone Part D drug plan. That either supplements their Original Medicare or can choose a Medicare Advantage plan with prescription drug coverage.

What is Medicare Part D?

A Part D plan is insurance for essential prescriptions. You pay premium to an insurance company for your Part D drug plan. There is a copay and percentage cost to you. Still, the insurance company will pay for part of your prescription medications. You will get a separate Part D insurance card that is separate from your other Medicare-related cards.

How does Medicare Part D work?

Below is essential information you should have about having a prescription drug policy: 

  • Annual Deductible — There's a deductible you pay for a prescription drug plan. Your deductible could be different or waived e, but the max amount you can be charged was $415 in 2019. You pay a reduced price for your medications until you have met the deductible. After that, you begin initial insurance.
  • Initial Coverage — During this period, you pay a copay for your medications based off your plan’s formulary. Each prescription drug plan has different tiers. Each tier has a copay amount for which you have to pay. Generic drugs typically separate it, preferred name brands, even more, specialized medications, etc. After you and the insurance company paid this, you will enter the coverage gap (donut Hole) which is technically going away in 2020. 
  • The Coverage Gap – In the coverage gap, you still have significant generic medication discounts. Typically, you will pay 25% for name-brand medications and 37% for generics. Your gap spending will continue until you paid $5100 out of your pocket in 2019, 2020 will be different. 
  • Catastrophic Coverage – If you spend past the coverage gap (donut hole), your plan will begin to pay 95% of the expenses of the formulary medications for the remainder of the year.

How to sign up for Prescription Drug Plan 

If you are enrolled in Original Medicare, you are eligible for Medicare Part D. If you are interested in getting assistance paying for your prescription drugs, talk to a licensed Medicare specialist at Songer Benefits, Inc.today!

Medicare Part D prescription Drugs

Medicare Part D is a prescription medication plan which helps outpatient drug coverage. Part D is sold through private insurance licensed with the government. 

If you want Part D prescription drug coverage, you have to either purchase a standalone plan or through a Medicare Advantage plan part C.

What drugs are covered with Medicare Part D?

Medicare Advantage Prescription Drug Plans (MA-PD) cover all vaccine drugs when needed to prevent sickness. Besides this, you will have a formulary unique to your policy that details what prescriptions are included. So, before you pick a plan, you need to talk to a licensed specialist at Songer Benefits, Inc. 

Drugs that aren't covered with Medicare Part D insurance?

Depending on your plan, this answer can change. However, here are some drugs that will most likely not be covered under any prescription drug plan: 

  • Any over-the-counter drugs
  • Fertility drugs
  • Drugs for erectile dysfunction
  • Weight loss or weight gain drugs
  • Any drugs for hair growth

If you're Medicare Part A or B you will foot the bill, Part D does not offer coverage.

If changes are coming, you are notified

Rest assured that all Medicare Prescription Drug Plans are required to inform you of any changes to its formulary on the plan’s website. The insurance company must also inform you when drugs are removed from the Part D formulary. 

Also, any changes must have the name of the medicine removed, if the drug changes tiers, the reason for the change, alternate drugs are available, any cost-sharing, and exceptions available.

Your rights to prescription drug plan In Beckley West Virginia 

Once you purchase a prescription drug plan in West Virginia, you have the right to: 

  • Lower copayments for higher-cost drugs if you or your prescriber believe you can’t take reduce-cost drugs for your condition
  • Ask for reasons if your plan does not cover a prescription you need
  • Ask for exceptions to waive coverage rules
  • Receive a explanation from your plan about the benefits

Download the Estimated Costs Table

Estimated drug costs are from Medicare.gov and based on medicines for the daily dosage — refilled every month — at a Walmart pharmacy in the 25801 zip code. If a generic version was not covered, then a brand name was used to estimate the cost (indicated by a ^). Some drugs are covered many times because they are used to treat multiple conditions. If someone takes more than one drug, they can estimate their costs by adding the drug together. However, they need to make sure their plan covers the combination of drugs before purchasing.