Part D
Guidelines for 2010
Also see a step-by-step
process for
Where Do I Start with Part D?
Summary of Part D (Prescription Drug Program)
for 2010
Medicare Part D
prescription drug coverage will change in 2010. First, the
deductible amount
increases from $295 to $310. Then the initial coverage
limit to reach the donut hole increases from $2,700
to $2830 (deductible + initial coverage section). Then the
next $3610 is to be paid from your pocket (donut hole, no
Medicare participation). If
you are unfortunate enough to need more than $6440 in
drugs ($2830 + $3610) during the calendar year, you enter
what is called "Catastrophic Coverage". In this category,
you will pay $2.40 for generics, and either
5% or $6.30 for brand
names--whichever is higher.
Remember, these are the general Part D guidelines.
Depending on the insurance provider you select, and the
premium you pay, you may experience variations.
Part D enrollees may be eligible for more help if there
has been a change in income status, such as from lost
income, retirement or disability. The time to change plan
coverage is Nov. 15 to Dec. 31.
During October all companies with Plan D coverage began
sending marketing materials for 2009. Also during October,
information will be sent about termination for Part D
coverage in 2009 and co-payment levels for beneficiaries
who continue to qualify but whose co-payment will change.
As a
place to start, try
this link to see
if you might qualify for additional help with Part D. You
may find additional help available from your state's
programs. More on that in the next paragraph.
Many
mailings may be difficult to understand. I know mine are.
A Social Security representative suggested to me today
that we should discuss our Part D plans with a state
representative who is qualified to help us with our
options. (My first choice) Go to the
SeniorArk "Government Links"
page, click your state on the map, and locate someone who
can direct you to the correct person. This is very
important, since they have studied the programs of the
many insurers, are aware of changes in the programs, and
can tell you if you qualify for additional state help with
prescription cost. You don't need to be poor to
qualify for this help in many states. You can also
go to our SeniorArk
"Medicare Tips" page where you can click on your state
from a list. This will show you the Part D insurer plans
that are available in your state, but you still need to
find a qualified state representative to help you decide.
Don't just talk with insurance company representatives
about you decision. They are salespeople. You need a
detached advisor who does not stand to gain financially
from your decision.
As
another option, the Social Security representative
suggested a talk with your pharmacist. Competition between
major pharmacies is intense for the Senior Part D
business. As a result, many are training their pharmacists
to help guide you through the maze of deciding on the
program that is best for you. Many of these folks may be
more informed than the state people.. But the state
representatives are important, since they may better
understand whether you qualify for additional help. These
folks can be very helpful, but you would still be
well-advised to seek out a state or Medicare employee for
advice.
This is how
Part D looks
in Chart Form :
2010
|
AMOUNT & ITEM
|
WHAT YOU PAY |
WHAT MEDICARE PAYS |
|
$500 PREMIUMS (varies) |
$500 est |
$0 |
|
$310 DEDUCTIBLE |
$310 |
$0 |
|
(25% / 75%) NEXT $2,520 |
$630.00 |
$1,890.00 |
|
$3,453.75 "DOUGHNUT
HOLE" |
$3,610.00 |
$0 |
|
TOTAL |
$5,050.00 |
$1,890.00 |
|
SO UNTIL $6.940 IS
SPENT, YOUR COST IS $5,050 ($4,550 if not counting
premiums) |
|
AFTER THAT YOU PAY $2.40 FOR EACH GENERIC, OR
$6.30 FOR EACH BRAND NAME, OR 5%
OF THE
TOTAL OF EACH PRESCRIPTION, WHICHEVER IS THE HIGHER
NUMBER. EXAMPLE: A $200 BRANDED DRUG COSTS YOU $10.00.
THIS SO-CALLED "CATASTROPHIC COVERAGE" CONTINUES ONLY
UNTIL DECEMBER 31, 2010 |
|
ON 1/1/11 IT ALL
BEGINS OVER AGAIN, WITH HIGHER PREMIUMS AND
DEDUCTIBLE, AND A LARGER DOUGHNUT HOLE.
Remember, if you have
been in Part D for less than a full year in 2009,
being in for a full 12 months in 2010 may mean
that the doughnut hole takes on a greater significance
for you. |
|
See:
Part D Charts for
years 2006, 2007, 2008. 2009. 2010 |
|
See:
Where Do I Start with Part D?
SeniorArk main
Medicare page
If all
else fails, go to
Medicare.gov,
or call them at:
1-800-633-4227 which is also 1-800-MEDICARE
*It might
be very helpful to view Part
"D" costs to you in
Chart Form, comparing 2006 thru 2009
|
