One of the most frequent areas of confusion for seniors and their healthcare is Part D drug coverage. With a new open enrollment period arriving every year, it’s important for seniors to not only know the details of common plans and how each company’s plans differ, but how new Medicare Part D regulations will effect their drug coverage in the coming years. In the world of ever-changing treatments and drug company acquisitions, it’s never a bad idea for a crash course!

As the majority of us leave the workforce, we’re used to the same group health insurance plan we’ve always had. Typical group health insurance plans have drug plans built in, removing confusion about price and ease of acquiring prescriptions. But, now you’re 65 and your world is turned upside down once you go onto Medicare – or so you may think. That first Part D enrollment may seem daunting. There are so many options to choose from. You have difficult insurance terminology coming up, but no idea what they mean for you. No need to worry, though, this is what everybody goes through the first year or two. With a little help, Part D enrollment will be a walk in the park!

For those out there who aren’t insurance savvy (let’s be honest, it’s the majority), hearing terms like coinsurance, copays and deductibles may be confusing. So, let’s take a minute to clear the water:

Coinsurance: If a drug plan has a coinsurance, that refers to the percentage of your prescription that you will be paying along with the insurance company. So, if a plan has a 10% coinsurance and you have a prescription that costs $100, you will pay $10 for that prescription.

Copay: A copay is a set dollar amount that you will have to pay for a prescription. Similar to a copay on a group health insurance plan, your copay is set by the plan you choose.

Deductible: Many of us are familiar with health insurance deductibles. In terms of a drug plan deductible, it works very similarly. Not all drug plans have deductibles, but some require you to pay a set dollar amount before the plan will pay any benefits.

So, what is this idea of open enrollment? In Part D terms, this is the period between October 15-December 7 of every year where Medicare-age seniors are able to re-enroll in a new Part D drug plan. The purpose of this period is to ensure that the initial drug plan you signed up for is still the most affordable for you. As years pass, certain prescriptions may be added or removed, changing the cost of plans altogether. This is why checking every open enrollment period for the most affordable plan is the best idea. Even if the plan you’re on is still the best for you, it gives you peace of mind knowing you’re where you’re supposed to be.

Remember when I said that the world of prescription drugs is always changing? Well, that will be more true than ever in the year 2019. Over the past few years, there has been a lot of complaints about the Part D coverage gap (also called “the donut hole”). According to Medicare’s website, the donut hole is described as the “temporary limit on what the drug plan will cover for drugs” and that “the coverage gap begins after you and your drug plan have spent a certain amount for covered drugs.” While not everyone will hit the gap, in 2018, that number is $3,750. So, once you hit that number in 2018, you will be responsible for a certain percentage of drug costs. Those costs go as followed:

Brand-name Prescription Drugs – Plan member will pay 35% of drug costs until the gap is met

Generic Prescription Drugs – Plan member will pay 44% of drug costs until the gap is met

There is good news, though. By the year 2019, the U.S. government is officially closing the donut hole! This means that those percentages will be dropped considerably, down to 25% until they reach catastrophic coverage.

So, now that you have a good base of knowledge over Medicare Part D, you can rest easy once open enrollment time comes around!

If you or a loved one are interested in everything that The Wellington Senior Living has to offer, give us a call!