
Medicare Advantage Plans Naples FL
Table of Contents Introduction How to Choose the Right Medicare Advantage Plan for You in Naples FL Exploring the Benefits of Medicare Advantage Plans in
Prescription drug coverage is available to Medicare beneficiaries. This plan reimburses you for a portion of your pharmaceutical costs. If you have Original Medicare, you can enroll in a Medicare Part D plan. You can also enroll in a Medicare Advantage plan that covers prescription drugs.
Drug insurance may not seem necessary if you are not currently using any expensive prescriptions. However, as soon as you sign up for Medicare, you should enroll in at least a low-cost medication plan. If you wait too long, you may find yourself needing to purchase coverage to assist pay for expensive drugs that can cost thousands of dollars each year. The financial consequences are severe. Learn more about how to approach this decision, which is one of many you’ll have to make while enrolling in Medicare.
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Even if you don’t presently take prescription medications, enrolling in Medicare Part D as soon as you’re eligible is a good idea. As previously stated, if you have Medicare Part A and/or Part B and live in the service area of a Medicare plan that provides prescription drug coverage, you are eligible for Medicare Part D.
If you don’t sign up for Medicare Part D, be sure you have other creditable prescription drug coverage, which is insurance that is equivalent to Medicare’s standard prescription drug benefit. If you don’t sign up for Medicare Part D when you first become eligible and go without creditable prescription drug coverage for 63 days or longer, you may be charged a late-enrollment penalty if you do so later. This penalty is a one-time charge added to your monthly Medicare Part D payment; you may be required to pay this higher premium indefinitely.
Some employer-sponsored health plans are creditable, but not all employer-sponsored coverage is. If you get health insurance via your company (or your spouse’s employer), you’ll be notified every year if your coverage is creditable. If you haven’t received this notice, check with your employer’s group coverage to see if your coverage is valid.
You don’t have to get Medicare Part D if you don’t want to. If you don’t sign up when you’re first eligible and don’t have creditable prescription medication coverage, you might have to pay a higher premium later if you decide to enroll.
Your Medicare Part D prices may vary by plan, insurance company, and area because Medicare plans set their own monthly premiums and other out-of-pocket fees. A monthly premium is required for each Medicare Prescription Drug Plan and Medicare Advantage Prescription Drug Plan. Keep in mind that your Medicare Part D premium is different from any monthly Medicare Part A or Part B premiums you may due. In addition to any monthly premiums needed by your Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug Plan, you must continue to pay your Medicare Part B premium. If you’re enrolled in a Medicare Advantage plan that includes prescription drug coverage, Your plan premium may include the cost of your Medicare Part D coverage.
If your income (as reported on your two-year tax return) exceeds a certain threshold, you may be required to pay an extra fee. This fee, commonly known as the Part D Income-Related Monthly Adjustment Amount (IRMAA), is separate from your Part D monthly premium and is subject to change each year. Unlike your Part D monthly payment, you’ll pay the Part D-IRMAA directly to Medicare, not your Medicare plan.
Social Security will notify you if you owe the Part D-IRMAA. From 7 a.m. to 7 p.m., Monday through Friday, call Social Security at 1-800-772-1213 (TTY users, 1-800-325-0778) for further information. Call the Train Retirement Board at 1-877-772-5772 (TTY users, 1-312-751-4701) from 9 a.m. to 3:30 p.m., Monday through Friday if you worked for a railroad.
Other Medicare Part D costs may include the following in addition to your monthly plan premium:
You can purchase a stand-alone Medicare Part D prescription drug coverage through a commercial insurance provider if you choose Original Medicare. UnitedHealth Group, Humana, and CVS Health, for example, cover around 56% of Medicare Part D enrollees. In 2021, half of Part D enrollees (50%) will choose a stand-alone plan.
Prescription drug coverage is usually included when you enroll in a Medicare Advantage (Medicare Part C) plan. Medicare Advantage prescription drug plans were chosen by half of Part D enrollees (50 percent) (MA-PD plans). Some of the many insurance companies that offer Medicare Advantage plans with prescription medication coverage are Aetna, Humana, and Blue Cross Blue Shield.
The types of prescriptions covered by each policy, as well as the amount you must pay, differ. Even the cheapest prescription medication plans must cover the majority of generic and brand-name pharmaceuticals, as well as insulin preparations, that people on Medicare require. It must also cover all or almost all of the medications in the following groups:
Vaccines, including shingles shots, that are not covered by Medicare Part B must be covered by Part D coverage. (Medicare Part B covers the annual flu shot, pneumococcal vaccine, and COVID-19 vaccine.) In 2022, the Medicare Part D insulin savings program will charge a maximum copayment of $35 for insulin treatment.
What isn’t covered under Medicare drug coverage?
Some of the drugs on the above list may be covered under plans with “enhanced alternative coverage.”
Coverage Limitations
To ensure that your prescriptions are covered and to learn about your out-of-pocket costs, check the plan’s formulary, or list of covered pharmaceuticals (deductible, coinsurance, copays). Prescription drug programs, whether stand-alone or as part of a Medicare Advantage plan, have distinct guidelines for limiting coverage for prescriptions depending on cost.
A generic drug, for example, may be deemed Tier 2 and will cost you relatively little out-of-pocket. Name-brand and specialty Tier 3-5 medications, on the other hand, may be much more expensive. Prescriptions may also require prior authorization, or you may be required to try a lower-cost medicine first.
Who Is Eligible for Part D of Medicare?
What is the cost of Medicare Part D?
Premiums
Monthly premium costs vary by plan and are determined by your income. Higher-income individuals will pay more. Single filers earning more than $91,000 and couples earning more than $182,000 will pay more in 2022. Adjustments to your premium may range from $12.40 to $77.90 each month.
Deductible
A deductible is an amount you must spend before the insurance company begins to pay its share. Deductibles are not required in some prescription programs. For 2022, the maximum allowable deductible is $480.
Copayment/Coinsurance
Copayments (a specific amount you pay for prescriptions in each tier) or coinsurance (a percentage you pay for the drug’s price) are two options in a drug plan.
What Is the Coverage Gap or Donut Hole?
You pay the cost-sharing specified in your policy until your total drug expenditures reach $4,430 in 2022.
What Is Extra Help and Who Is Eligible?
Through Medicare’s Extra Help program, you may be eligible for cheaper premiums, deductibles, and coinsurance. Participants in the program will pay $3.95 for each generic prescription and $9.85 for each brand-name drug in 2022.
If your income is up to $19,320 for an individual and $26,130 for a couple in 2022, and you have a restricted amount of savings, stocks, and bonds, you may qualify. You can apply for Extra Help at any time if your income or resources change.
When Can You Enroll in Medicare Part D?
Initial Enrollment Period
You can add a stand-alone Part D medication plan or join a Medicare Advantage plan with drug coverage when you turn 65 and become newly eligible for Medicare. You can transfer from a Medicare Advantage plan to Original Medicare and purchase a stand-alone drug coverage within the first 12-months of initial enrollment. Those under the age of 65 who qualify for Medicare can enroll in Part D prescription drug coverage when they first become eligible.
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Annual Election Periods
During the Annual Open Enrollment Period, which runs from October 15 through December 7, you can update your prescription medication coverage. Your new plan will begin on January 1st. You can also change Medicare Advantage plans or switch to Original Medicare during this time.
You can change Medicare Advantage plans (with or without drug coverage) or move to Original Medicare and join a Part D prescription drug plan during a distinct election period called the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31.
Special Enrollment Period
Certain life events, such as relocating to a new residence, entering or exiting an institution (such as a skilled nursing facility or prison), and other exceptional circumstances, may qualify you for a special enrollment period to alter your Medicare Advantage or Medicare prescription medication coverage.
Find a Medicare Drug Plan in Your Area
For a list of stand-alone Part D plans and Medicare Advantage plans with drug insurance available in your ZIP code, use the online Medicare Plan Finder tool. The comparison tool displays the prescriptions covered by each plan, as well as cost-sharing amounts, prior authorization requirements, and preferred pharmacies.
Choose the Right Prescription Drug Plan for You
Here are a few pointers on how to pick a plan that fits your budget, needs, and interests.
Medicare prescription drug coverage: Read More
Special Enrollment Period
Certain life events, such as relocating to a new residence, entering or exiting an institution (such as a skilled nursing facility or prison), and other exceptional circumstances, may qualify you for a special enrollment period to alter your Medicare Advantage or Medicare prescription medication coverage.
Special Enrollment Period
Certain life events, such as relocating to a new residence, entering or exiting an institution (such as a skilled nursing facility or prison), and other exceptional circumstances, may qualify you for a special enrollment period to alter your Medicare Advantage or Medicare prescription medication coverage.
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“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800 MEDICARE to get information on all of your options.”