This document provides information about Medicare drug coverage including how to enroll, what plans cover, costs, and penalties. It explains that Medicare drug plans are run by private insurers and have formularies of covered drugs divided into tiers with different costs. Premiums, deductibles, copays, and coinsurance are defined as the various costs individuals pay depending on their plan and income. The coverage gap and extra help programs are also summarized. Resources for more information are listed at the end.

1. Audrie Lopez BOS 224

2. HOW TO GET
DRUG COVERAGE
Join a plan run by an insurance company or other
private company approved by Medicare
Once a plan is picked, use a step from below to
enroll:
Medicare Plan Finder or on the plan's website.
Complete a paper enrollment form.
Call the plan.
Call 1-800-MEDICARE (1-800-633-4227)

3. WHAT DRUG PLANS
COVER
• Each Medicare Prescription Drug Plan has its own list
of covered drugs, called a formulary.
• Many Medicare drug plans place drugs into different
"tiers".
• Drugs in each tier have a different cost.
• A drug in a lower tier will generally cost you less than a
drug in a higher tier.

4. COSTS FOR MEDICARE DRUG
COVERAGE
• Premium- Periodic payment
to Medicare, insurance
company, or other health
care plan for coverage.
• Most plans charge a
monthly fee that varies.
• You pay this in addition
to the Medicare Part B
premium.
File individual tax return File joint tax return
File married & separate tax
return
You pay (in 2014)
$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000
above $170,000 up to
$214,000
not applicable $12.10 + your plan premium
above $107,000 up to $160,000
above $214,000 up to
$320,000
not applicable $31.10 + your plan premium
above $160,000 up to $214,000
above $320,000 up to
$428,000
above $85,000 up to $129,000 $50.20 + your plan premium
above $214,000 above $428,000 above $129,000 $69.30 + your plan premium
PART D PREMIUMS BY INCOME (2012)

5. • Yearly Deductible- Amount you must pay each year for
your prescriptions before your Medicare Prescription Drug
Plan begins to pay
• Deductibles vary between Medicare drug plans.
• Some Medicare drug plans don't have a deductible.
• Copayment/coinsurance-The amount you pay for each of your
prescriptions after you have paid the deductible (if your plan
has one) is either a copayment or coinsurance.
• Some Medicare Prescription Drug Plans have different
levels or " tiers " of copayments or coinsurance.

6. • Example of copayment/coinsurance:
• With a copayment, you pay a set amount (say, $10)
for all drugs on a tier.
• Coinsurance means you pay a percentage of the cost
(like, 25%) of the drug.
• Coverage gap- Temporary limit on what the drug plan will
cover. Coverage gap begins after you and your drug plan have
spent a certain amount for covered drugs.
• Not everyone will enter the coverage gap; this amount
may change each year.
• Once coverage gap is reached, you'll pay a certain
percentageof the plan's cost for covered brand-name
prescription

7. • Extra Help- Medicare program to help people with limited
income and resources pay for prescriptions drug program
costs, like copays, coinsurance, and premiums.
• Call 1-800-MEDICARE (1-800-633-4227).

8. LATE ENROLLMENT PENALTY
• You may owe a late enrollment penalty if, at any time
after your initial enrollment period is over.
• There's a period of 63 or more days in a row when
you don't have Part D or prescription drug coverage.
• The cost of the late enrollment penalty depends on
how long you went without creditable prescription
drug coverage.
• Your plan will tell you if you owe a penalty, and what
your premium will be.

9. OVERALL, YOUR ACTUAL DRUG
PLAN COSTS WILL VARY
DEPENDING ON:
The drugs you use
The plan you choose
Whether you go to a pharmacy in your plan's network
Whether the drugs you use are on your plan's formulary
Whether you get Extra Help paying your Medicare Part D
costs

10. RESOURCES
 http://www.medicare.gov/ (Main Medicare website)
 http://www.cms.gov/ (Center for Medicare &Medicaid Services)
 https://www.medicare.gov/find-a-plan/questions/home.aspx (Medicare Plan
Finder)
 https://www.medicare.gov/contacts/state-search-
results.aspx?stateresult=ALL&stateabbr=MI|Michigan (Michigan
organizations available to help)
 Phone:1-800-MEDICARE (1-800-633-4227)
 TTY: 1-877-486-2048
 Mailing address
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850