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Prescription  Drug Plans

4 Important Facts

Medicare prescription drug plans; also known as Part D or PDP plans are standalone plans that are provided by private insurance companies. A Part D plan provides coverage for prescription drugs and medications. The purpose of such plans is to lower the cost of prescription drugs allowing treatment to be more accessible. Some vaccines may also be covered.

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Medicare Part D plans have certain things you must take into consideration when comparing one PDP plan vs another. It all depends on your needs and what is best for you.

Monthly Premiums

Your monthly premium is how much you pay per month to keep the plan active. The premium can vary greatly depending on your personal needs and preferences. But regardless of the premium, it is ideal that you understand the pricing of your medications and if those medications are covered under a given plan. Premiums can increase from year to year so be sure to read all communication from your insurance carrier to be notified of any changes.

2

Drug Deductibles for Medicare

Prescription drug plans have deductibles just like individual or employer health insurance plans. The deductibles for each plan are located in the plan's summary of benefits. But when comparing multiple plans it is best to seek out professional help from an insurance broker. There are plans available with a $0 deductible, but just because a deductible is $0 doesn't mean that it would be the best plan for you. Lower deductible oftentimes means a higher premium, keep this in mind.

3

Initial coverage limit (ICL)

Medicare Prescription drug plans usually have four different parts of coverage: (1) Deductible, (2) Initial Coverage, (3) Coverage Gap, and (4) Catastrophic Coverage. Your monthly premium does not affect these phases.

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The initial coverage phase is where most people stay throughout the year. The initial coverage phase has an initial coverage limit. The initial coverage limit is a fixed dollar amount that separates the initial coverage phase from the coverage gap. Once you surpass the limit you will move into the next phase. For 2023, the ICL is $4,660 and is based on the plan's formulary drugs retail value.

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4

Formulary

Every plan that offers prescription drug coverage has a list of drugs that a specific plan covers this is called the formulary. The formulary is there as a guide to ensure that your medications are covered under a given plan. The formularies are usually updated on an annual basis, so it is important that you review this document annually. Any changes to the formulary will be sent to beneficiaries with a document called an annual notice of change (ANOC).

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Arnett Evans and Company

© 2024 Arnett Evans and Company. All rights reserved. AEC is a trademark and marketing brand of Arnett Evans and Company.

We do not offer every plan available in your area.  Currently, we represent 10 organizations that offer 150 products in your area. Any information we provide is limited to those plans we do offer in your area. Please get in touch with MEDICARE.gov or call 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get information on all your options.

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Plan features and availability may vary by service area. Arnett Evans and Company, AEC, is not a government entity, neither does the owner(s), or company claim to be associated with any local, state, or federal governments outside of the licensure of writing agents or brokers through the Secretary of State in the given area in which agents/brokers are licensed to sell insurance products.

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All insurance carriers that we represent, within the Medicare ecosystem, is a HMOs, and PPO plans with a Medicare contract. Our D-SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Plan features and availability may vary by service area. Participating healthcare providers are independent contractors and are neither agents nor employees of the carrier plans they accept, except in situations in which you are notified otherwise by the carrier. The availability of any particular provider can not be guaranteed, and provider network composition is subject to change. Every year, Medicare evaluates plans based on a 5-star rating system.

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See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations, and conditions of coverage. Plan features and availability may vary by service area.

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The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice before such a change when necessary from your plan's carrier.

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Each carrier's brand name for insurance products issued by the subsidiary insurance companies is controlled respectively by the carrier and /or its company structure. None of the carriers we represent nor, Arnett Evans Jr, Arnett Evans and Company, or AEC Insurance are connected with or endorsed by the U.S. Government, State and local government and municipalities, or the Federal Medicare Program.

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This site is owned and operated by Arnett Evans a licensed representative of all carriers presented during a booked one-on-one presentation and is not the official website of any carrier in which we represent.

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