Monday, February 10, 2014

How Does Medicare Part D work?

How Does Medicare Part D work?  

You will pay an Insurance Company a monthly premium and in return you will receive 3 levels of coverage.

Level 1: This is the type of prescription that you are used to, during the first level of coverage you will pay a set copay for each of your medications.

  • ·        Typically you will pay $0-4 dollars for Tier 1 generic medications
  • ·        Typically you will pay $12-20 dollars for Tier 2 generic medication
  • ·        Typically you will pay $35-40 dollars for Tier 3 “Preferred Brands”
  • ·        Typically you will pay $80-95 dollars for Tier 4 “non-Preferred Brands”

Level 2: Level 2 is often referred to as, “The Donut Hole”. You will reach level 2 coverage when your costs plus the costs that your insurance company has spent reaches $2,970.00 dollars. Once you reach level 2, you will not have a simple copay to pay, instead you will pay “co-insurance”, which means you will pay a percentage of what the insurance company is paying for each medication.
  • ·        Typically you pay 79% of generic medications
  • ·        Typically you pay 47.5% of brand name medications

Level 3: Once you and your insurance company have paid out about $4700 for your medications, you enter, “Catastrophic coverage”. Once you enter this level of coverage, your cost per medication is reduced substantially, and you are guaranteed to pay a small co-insurance for each medication.



Donut Hole Relief: Currently, you are required to pay 79% for Generics and 47.50% for Brand name medications, however these percentages are being reduced every year, and in 2020 the highest percentage you will pay is only 25%.

My name is Robert Bache aka, MedicareBob. I am a licensed insurance agent and I specialize in Medicare. Please contact me with any of you Medicare Insurance questions. 
Phone Number: 1-800-525-0299
www.MedicareBob.com 
www.SrHealthcareDirect.com 
Robert@SrHealthcareDirect.com 


2 comments:

  1. What has happened to this blog? Doesn't anyone post anymoer?? Too bad!!!!! John L.

    ReplyDelete
  2. Thanks for clarifying that Level 2 is often referred to as, “The Donut Hole” Im trying to get this through to customers.
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    ReplyDelete