Part D Supplement

At Landmark Insurance & Financial Group we know that taking prescription medication is an important part of many people’s lives, from blood pressure medication to anti-depressants, it is important that we take our medication.

Medicare Part D helps pay for outpatient prescription drugs and is available through private health organizations or carriers. Often Medicare Advantage Plans (Medicare Part C Plans) include Medicare Part D Prescription Drug Coverage.

The amount that you pay for your prescriptions is determined by several factors, these include:

  • Premiums
  • Yearly Deductibles (if applicable)
  • Co-Payments or Co-Insurance
  • Costs in the Coverage Gap
  • Costs if you Get Extra Help
  • Costs if you Pay a Late Enrollment Penalty

Your Actual Drug Plan Will Vary Depending On:

  • The Prescriptions You Use
  • The Plan You Choose
  • If You Use an In-Network Pharmacy
  • If the Prescriptions are on Your Plans Formulary

Call Landmark Insurance today to speak with one of our health care specialists to go over you Medicare Part D Prescription Drug Benefits.

Medicare Part D Prescription Coverage

Words to Know

Deductible – This is the amount you pay for covered health care services BEFORE your insurance plan starts to pay. For example: with a $2,000 deductible, you pay the first $2,000 of covered services yourself- after you pay the $2000 deductible, you usually pay only a copayment or coinsurance for covered services.

Co-Pay – This is a fixed amount that you pay for a covered health care service such as a Doctor’s Office Visit, after you’ve paid your deductible. For example, let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20, if you’ve paid your deductible. If you haven’t met your deductible: You pay $100, the full allowable amount for the visit.

Co-Insurance – This is the percentage of costs of a covered health care service such as a Doctor’s Office Visit where you pay (20%, for example) AFTER you’ve paid your deductible. Let’s say your health insurance plan’s allowed amount for an office visit is $100 and your coinsurance is 20%. If you have paid your deductible, you will pay 20% of $100, or $20. The insurance company pays the rest. If you haven’t met your deductible: You pay the full allowed amount, $100.

Brand Name Prescriptions – These are prescription drugs marketed with a specific brand name by the company that manufactures it, usually the company which develops and patents it.

Generic Prescriptions – A generic drug is identical -or bioequivalent -to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. However, they are marketed without brand names and are generally less expensive than brand-name drugs, even though meet the same standards of the FDA (US Food and Drug Administration) for safety, purity and effectiveness. Generic drugs can be legally produced in the US if a patent has expired, or for drugs which have never been patented.

Formulary Prescriptions – A drug formulary is a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. A committee of physicians, nurse practitioners, and pharmacists maintain the formulary.

Non-formulary PrescriptionsNon-formulary drugs are usually not covered by your plan even if the doctor declares that it is medically necessary. You can still have a non-formulary medication filled, but you will have to pay the full price of the drug.