How Do Prescription Drug Plans Work?
Here is important information you need to know about owning a prescription drug plan:
Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $545 in 2024. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copay amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications. In 2024, the initial coverage cap is $5,030. After you and the insurance company together have paid this amount, then you enter the coverage gap.
The Coverage Gap (Donut Hole) – During the coverage gap, you will still have significant discounts for generic medications. Most generic and brand-name drugs receive a 75% discount from the drug manufacturer and the government. So you will typically cover 25% of the cost until reach the Part D True Out-of-Pocket limit of $8000 in 2024.
Catastrophic Coverage – If you exceed the coverage gap, your plan will begin to pay 100% of the costs of your formulary medications for the rest of the year.
How would I enroll?
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Phone: 517.300.2101 Email: David@MidMichiganMedicare.com
*We do not offer every plan available in your area. Currently we represent over 20 organizations, which vary the number of products we offer in your area. Please contact
Medicare.gov, 1800Medicare, or your local State Health Insurance Program (SHIP) to get information on all your options.*
*This disclaimer is required by CMS (Center for Medicare & Medicaid Services) and we need to advise you that contacting Medicare.gov and SHIP may not be in your best interest. The representatives from Medicare are not versed on different doctor networks, and all the differences in plan designs. SHIP representatives are volunteers that receive 8 hours of training and cannot make recommendations. The average trained Medicare agent completes 40 plus hours of training annually and are held to a high standard of compliance and accountability. We will look at all your options and recommend what we feel would be best for you based on your needs.
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