- Posted by Canopy KC
- On February 2, 2017
- 0 Comments
- avoid costly health insurance, buy a health insurance plan, canopy, choose the right plan, Medicare Part D
Medicare is the federal system of health insurance coverage for those 65 years or older or those younger with qualifying disabilities. Traditionally, each Medicare component experiences changes in deductibles, co-pays, and monthly premiums on an annual basis and the Medicare Part D changes for 2017 will not be any different.
- Open Enrollment: October 15, 2016 – December 7, 2016.
- Coverage Period: January 1, 2017 – December 31, 2017.
- You must enroll in Medicare Part A or B to be eligible for Part D.
- Enrolling in Part D is not mandatory upon Medicare eligibility if you have drug coverage preferred to Medicare. However, if you delay signing up for Part D and later need it, you will have to pay a permanent monthly penalty in addition to the monthly premium.
- Annual Coverage Cycle: Deductible, Initial Coverage Period, Coverage Gap, Catastrophic Coverage.
There are multiple plans based on Medicare approved drug formularies. Drugs are categorized into Tier’s 1-4 that directly relate to drug cost and are subject to change at any time. These plans are best suited to be discussed with a licensed Senior Market Consultant.
- Medicare Advantage (MA) plans are contracted by the government using private health insurance companies to incorporate Part A, Part B and Part D (prescription coverage); they are typically either an HMO or PPO. There are multiple Medicare approved plans based on Medicare approved drug formularies, which in turn adjusts monthly premiums.
- Part D Stand Alone Plan (PDP) plans are prescription drug coverage only. There are multiple Medicare approved plans based on Medicare approved drug formularies, which in turn adjusts monthly premiums.
Unfortunately, 2017 will bring an increase in annual deductibles monthly premiums, drug cost and co-pays per plan.
- Monthly Premium: Medicare has made changes in 2017 to it’s approved drug formularies. Each formulary and plan have unique monthly premiums.
- Annual Deductible: The amount paid out of pocket prior to coverage increased to $400 (2017) compared to $360 in 2016. It is important to note that some Medicare drug plans do not have a deductible.
- Prescription Share Cost: This cost is either a co-pay or a set percentage of the drug cost during the initial coverage period beginning January 1, 2017. This share cost occurs until you and your plan have paid $3,700 (2017) compared to $3,310 in 2016.
- Coverage Gap/Doughnut Hole Cost: If your drug costs exceed the initial coverage limit as defined by your chosen plan, your coverage falls into a gap or “doughnut hole.” While in this gap, in 2017 you will pay approximately 40% (out of pocket) for brand name drugs and 51% (out of pocket) for generic drugs. This gap coverage ends once you have paid $4,950 (2017) compared to $4,850 in 2016. Following this coverage gap, catastrophic coverage kicks in and your plan pays approximately 95% of remaining drug costs.
- Pharmacy and Provider: Not all pharmacies are the same. They differ in whether they offer mail order, preferred or generic cost sharing and can be out of network. Your pharmacy may have been in network in 2016 and moved to out of network in 2017. It is important to do your research. In 2017, Medicare is requiring that the majority of prescription prescribers need to be enrolled in Medicare for your Medicare drug plan to cover your prescriptions. It is important to have this discussion with your prescriber to avoid paying for your prescription at full cost.
Understanding your Medicare options and Medicare Part D changes for 2017 can be greatly enhanced by seeking help from a Senior Market consultant here at Canopy. A free face to face or phone consultation will help to answer the most basic to the most complex questions regarding this very important health care coverage.