Medicare Part D

Medicare part d

DEPENDING ON YOUR INCOME AND RESOURCES, YOU MAY QUALIFY FOR EXTRA HELP PAYING FOR YOUR PRESCRIPTION DRUGS

Medicare Prescription Drug Coverage

Medicare Part D — Medicare Prescription Drug Coverage

Medicare Prescription Drug Plans are approved by Medicare and designed to cover your outpatient and maintenance prescription drugs. It enhances your Original Medicare and/or Medicare Supplement Insurance Plan coverage. Even if you don’t take any prescription drugs, consider enrolling when you become eligible. You want to protect your health and finances and be covered if your situation changes.

How Medicare Prescription Drug Coverage Works

Medicare Part D helps you pay for your prescription drugs. Because Part D is a government program, the Centers for Medicare and Medicaid Services (CMS) closely oversee every aspect of the program. Every detail, from the drug list (also called the formulary) to how an insurance company sells its plans, is reviewed and approved by CMS.

Before an insurance company can sell Medicare Part D coverage, it must have its proposed benefits, premiums and the drug list approved by CMS. This makes sure the coverage follows federal guidelines and it protects you as a Medicare beneficiary.

Medicare Part D Eligibility

To be eligible for Medicare Part D, you must:

Be entitled to Medicare benefits under Medicare Part A and/or enrolled in Medicare Part B
Reside in the Part D plan’s service area
Not be enrolled in more than one Medicare Part D plan at a time

If you are under 65 with a disability, you may also be eligible to enroll.

The four phases of Medicare Part D prescription drug plans

All Part D plans have these phases. Benefits offered by each carrier can vary.

Annual Deductible:

You pay this amount for your prescriptions before the private insurance company you choose begins to pay.

Initial Coverage:

You pay a copay or coinsurance for each eligible prescription filled.

Coverage Gap:

You pay your prescription drug costs until you reach a year-to-date True Out-Of-Pocket (TrOOP) cost (payments including deductibles, copays, coinsurance). During this time, you may be eligible for a discount on brand name drugs and a discount on generic drugs at the time of purchase.

Catastrophic Coverage:

You pay a copay for generics, a copay or coinsurance (whichever is greater) for other drugs, and coinsurance for specialty drugs after TrOOP costs are reached.

THE HEALTH CARE LAW

Depending on your income and resources, you may qualify for extra help paying for your prescription drugs. If you qualify, you will only pay a small amount for your prescriptions and will have continuous coverage. If you have not already received an application for assistance, contact your State Medical Assistance office or the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov.

If you have additional questions, or if you’d like to learn more, you can call Medicare at 1-800 MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also visit www.medicare.gov for the latest news on this program.

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Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

Medicare Advantage Plan Notice:

HMO, HMO-POS and PPO plans provided by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.

Medicare Part D Plan Notice:

Prescription drug plans are provided by Blue Cross and Blue Shield of Texas, which refers to HCSC Insurance Services Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC’s plans depends on contract renewal.

Medicare Supplement Notice: (If applicable)

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Medicare Supplement insurance plans are offered by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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