Medicare Prescription Drug Coverage

As you near retirement age, you may be concerned about how you will continue to pay for your prescription medications. In many cases, insurance through your employer pays in part to this drug coverage. Without this insurance, the expense of your medications may be intimidating.

The first thing you need to confirm is whether you qualify for Medicare. Then, you can further access your specific benefits from there. Understanding this program before you need it is very helpful as you near retirement.

How you qualify for Medicare:

– Your age can make you eligible.

You will become eligible for Medicare when you reach age 65. This is designed to be close to the age that you retire. Many people work until they are at least 65 in order to qualify for this program. This helps assure that you are able to transition to receive this close to when your insurance benefits run out after you retire.

– If you receive Social Security Disability Insurance or SSDI and are under 65, you can still qualify.

It is possible to be eligible for Medicare if you are under 65. If you have been receiving SSDI checks for over 24 months, you should qualify for Medicare. In the next month, you will be automatically enrolled.

In the case that you have Amyotrophic Lateral Sclerosis, or ALS, you are enrolled immediately. You do not have the 24 month waiting period. You can also qualify under 65 if you have End-Stage Renal Disease, or kidney failure. When you can start receiving benefits in this case depends on your specific circumstances.

Information about Medicare drug coverage:

– If you have Medicare, you are eligible for drug coverage.

If you already qualify for Medicare, you will be offered prescription drug coverage. If you decide not to take this right away and want it later on, you may have to pay a late enrollment penalty.

– There are two ways to drug coverage.

The Medicare Prescription Drug Plan (Part D) are plans offered by insurance companies and other private companies and are approved by Medicare. The Medicare Advantage Plan (Part C) is a health plan that is offered by a private company that contracts with Medicare. This is in order to provide you with all Part A and Part B benefits. Most Medicare services are covered through the plan and offer prescription drug coverage.

What is the coverage gap?

– There is a coverage gap for most of these plans.

This signifies that there is a temporary limit on what this plan will cover for your prescription drug coverage.

– Not everyone enters into the coverage gap.

This coverage gap will begin after you and your plan have spent a certain amount for your covered drugs. This number can change each year, so it’s important to keep up to date with this. For 2017, the number was $3,700.

After you reach this number, you will pay no more than 40 percent of the plan’s cost for covered and brand-name prescription drugs.

This will help you save money. It is possible to get these savings if you buy prescriptions through the mail or through a pharmacy.

– It is different for generic drugs.

During the coverage gap, Medicare pays 49 percent of the price of the generic drugs and you will have to pay the rest of this. The amount you pay for these generic drugs will decrease each year until it reaches 25 percent.

– Things that count toward your coverage gap.

Copayments, coinsurance and yearly deductible count toward the coverage gap. The discount you get on brand-name drugs in the coverage gap and what you pay in the coverage gap also count. Drugs that aren’t covered, a pharmacy dispensing fee and the drug plan premium do not count.

There are many things that you need to consider when investigating Medicare Prescription Drug Coverage. Depending on your individual circumstances, things could change. This website is a great resource for additional questions.

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