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Prescription drugs

HOW WILL MEDICARE AFFECT MY CURRENT INSURANCE?

If you are or will soon be enrolled in Medicare you should consider its effect on your prescription drug insurance needs. Even if you do not take any prescription medications now you may still need to join a prescription drug insurance plan or you may choose to remain in your current plan.  Your need to change plans depends on the prescription drug coverage you have now. To decide, you will have to compare the annual costs of your current prescription plan to the annual costs of a Medicare Part D plan.Costs include premiums, deductibles, co-pays and co-insurance you pay out of pocket.  Also, you need to confirm your current plan is "creditable coverage".  If you do not currently have prescription drug insurance coverage, then you likely need to join a plan now to avoid paying a higher premium for late enrollment in the future.

WHAT ARE MY OPTIONS?

You may remain in your current plan if it is "creditable coverage", (employer group coverage for instance). If it is not creditable coverage, you may enroll in a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage Plan that offers prescription drug coverage (MAPD) or you may enroll in Wisconsin Senior Care. Employer group health insurance coverage was purchased by you through your work or as part of your retirement from work.  The prescription part of that coverage is combined with a medical plan and usually can not be separated from it, but if you use a lot of prescription medications or if you take a very expensive medication, it may be less costly for you to stay in that health plan due to the coverage gap connected with Part D. Medicare Prescription Drug plans add drug coverage to Medicare but are two separate insurance plans. Medicare Advantage Plans that include Prescription Drug coverage combine Medicare and Prescription Drug coverage together in one plan.  Wisconsin Senior Care is Wisconsin's prescription drug assistance program for Wisconsin residents who are 65 years of age or older.

 HOW DO I COMPARE COSTS?

First learn the real costs of your current medications so you may compare them to the costs of other prescription drug plans. Be sure to use the exact name, spelling and dosage amounts for the medicines you are taking. If you are unsure ask your pharmacist for a list or printout. Costs include your plan premium, deductible, drug co-pays or co-insurance you pay each time you re-fill your meds. Take the same list of medications and learn fhe costs of your current prescription drug plan, then use the Medicare Prescription Drug plan finder to access information about the cost of Medicare Part D plans available in your area.

WHEN DO I JOIN A PART D PLAN?

If you are enrolling in Medicare now, you may join a Medicare Drug plan now. If you already have a Medicare Prescription Drug plan you may switch between November 15 and December 31 (annual election period) of each year. If you qualify for special circumstances, you may be able to join or leave a plan anytime you choose.

WHAT IS THE COVERAGE GAP?

After you and your plan have spent a certain amount of money for covered medications, you have to pay all costs of your medications up to another limit. The amount you have to pay out-of-pocket is called the "coverage gap". More specifically, you pay all drug costs after you and your plan have paid $2,930.00 until you have paid a total of $4,700.00 out of pocket, then you pay 5% of all costs thereafter for the year.

SOURCES OF PRESCRIPTION DRUG INSURANCE COVERAGE:

There are many sources of prescription drug insurance coverage to choose from; Employer / Retiree Group plans, Wisconsin SeniorCare, Medicare Supplement Insurance, Health Insurance Risk Sharing Plan (HIRSP), Medicare Advantage Plans, Medicare Presciption drug (Part D) Plans, Medical Assistance and Buy in Programs and Veterans Benefits or TriCare Military Coverage.

Helpful Links

Needymeds

CMS Prescripton Drugs Information

 


 

 
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Board on Aging & Long Term Care
1402 Pankratz Street, Suite 111
Madison, Wisconsin  53704-4001
FAX:  608 246 7001
BOALTC@Wisconsin.Gov