10 North Shore Towers Courier n March 2015 Felice Hannah’s MEDICARE CORNER CHANGES IN MEDICARE DUE TO THE AFFORDABLE HEALTHCARE ACT What’s New in 2015? NOTE: If you are enrolled in a Medicare Advantage Plan (Part C) always check with the Plan’s Admininistrator for clarification of benefits and coverage If you were enrolled in Medicare Part A/B in 2014 you received the following information from your Health/Prescription Drug Plan Provider informing you about changes for 2015. It is important that you read these documents and keep them handy as reference throughout the year. Annual Notice of Change for 2015 gives you a summary of cost and changes that will take effect January 1, 2015. Evidence of Coverage (EOC) is a legal detailed description of your rights, benefits and coverage if you remain enrolled in your current plan in 2015. Summary of Benefits gives more detailed information about your cost sharing and benefits. As a result of the Patient Protection Rights Act and the Affordable Health Care Act, Union Welfare Funds will mail annual detailed information regarding Welfare Fund Notice of Change in Benefit Coverage. List of Covered Drugs (Formulary) is a partial drug list of covered drugs in 2015. It informs you of any changes in drug cost and restrictions. NOTE: You or the prescriber can request an exception to the plan for drugs that have restrictions. A complete list of covered drugs, cost and restrictions can be obtained by going to the Prescription Drug Plan (PDP) website. Restrictions include but are not limited to: FormularyDrugs on formulary are covered by your plan. If not on formulary you will be charged the full cost of the drug Prior AuthorizationThe drug plan must be contacted before you can fill the prescription Quantity LimitLimits how much medication you can get at a time. You may now request less than a 30-day supply for a drug if, for example, the drug has known side effects or you want to synchronize the refills of all medications. Step TherapyYou must try one or more lower cost drugs. TiersDrug plans place drugs in “tiers”. The lower tier will generally cost less. The Drug Payment Stage resets each January 1st and is explained in your EOB Statement. • Stage 1 yearly deductibleThe beneficiary pays 100% of the cost of the drug until the deductible is met. • Stage 2 Initial Coverage is cost sharingThe plan pays 75% of the cost and you pay 25%. You remain in Stage 2 Initial Coverage until the Total Drug Cost in 2015 reaches $2,960. • Stage 3 Coverage Gap (Donut Hole)If you are enrolled in a Part D Plan you will receive a discount on brand name and generic drugs that are on formulary. The total cost of the brand name drug on formulary counts towards your total out of pocket cost. In 2015 you remain in Stage 3 Coverage Gap until your total out of pocket costs reaches $4,700 (total drug costs $6,680). • Stage 4 Catastrophic CoverageYou generally stay in this stage till the end of the year. The plan pays most of the cost. You pay $6.35 for brand name drugs or 5% whichever is greater. Cost for generic drugs in this stage cost $2.55. 2015 North Shore Towers resident Felice Hannah is a New York State Certified Medicare Volunteer Consultant and North Shore Towers Board of Directors Political Action Chairperson. BY FELICE HANNAH
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