FOR BREAKING NEWS VISIT WWW.QNS.COM NOVEMBER 1, 2018 • HEALTH • THE QUEENS COURIER 39
health
MEDICARE
AND MEDICAID
ENROLLMENT
From deductibles to donuts, key terms
to know about Medicare Part D
Navigating the ins and outs of Medicare
can be an intimidating experience if
you’re not familiar with certain terms.
Medicare Part D, which helps cover
prescription drugs, has its own terminology.
Medicare Annual Enrollment runs
from Oct. 15 to Dec. 7, so now is the time
for a refresher on key words to inform
your coverage decisions for 2019.
Deductible, copay
and coinsurance
A deductible is the amount you pay out
of pocket in a given year for eligible prescription
drugs before your plan’s coverage
kicks in. Th e deductible can vary from
plan to plan.
Some plans charge a copay, a fl at fee,
each time you fi ll a prescription. For
example, a plan may require you to pay
$2 when you fi ll a prescription for generic
drugs and a higher amount for brandname
drugs.
With coinsurance, you pay a set percentage
of the cost of the drug instead of
the fl at fee associated with a copay.
Formulary
Part D plans are off ered by private
insurance companies, and each plan has
what’s known as a formulary, a list of
the prescription drugs covered under the
plan.
“When considering a Part D plan,
review the formulary to make sure your
medications are covered,” said Kent
Monical, senior vice president for Part
D at UnitedHealthcare Medicare &
Retirement.
And keep in mind that plan formularies
can change from year to year, so don’t
assume that the prescription drugs covered
under your current plan will carry
over in 2019.
Drug tiers
A Medicare Part D plan’s formulary is
made up of tiers, depending on the cost
of the medications. Th e lower tiers generally
include preferred generic drugs, and
many plans cover these medicines with
low or no copay or coinsurance.
Higher tiers generally include brandname
drugs and specialty medications
and tend to have higher copays or
coinsurance. So, talk to your doctor
to see if the brand-name prescription
you take can be replaced with a generic
version.
Preferred pharmacy network
A Part D plan may designate a preferred
network of pharmacies, and if you use
these pharmacies, you can save money on
prescriptions.
“Make sure the plan off ers access to
pharmacies that are convenient for you,”
Monical said. “Some plans also have
mail-order pharmacy benefi ts, and you
may be able to get prescriptions delivered
to your home for a lower cost than purchasing
from a retail location.”
The donut hole
Th e majority of Part D plans have a coverage
gap known as a “donut hole.” For
example, in 2019, you enter this donut hole
once your out-of-pocket costs (including
deductibles, copays and coinsurance) for
prescription drugs reach $3,820. While
you’re in the donut hole, you will pay a
percentage of the cost of the drugs.
In 2019, once your out-of-pocket costs
reach $5,100, you exit the donut hole and
pay a smaller coinsurance. But, the days
of the donut hole are numbered. Under a
provision of the 2010 Aff ordable Care Act,
the coverage gap has been steadily shrinking.
Beginning in 2019, the maximum you
will pay in the coverage gap for a branded
drug is 25 percent of a drug’s cost. For
generic drugs, it is 37 percent, but in 2020,
that will be reduced to 25 percent as well.
To learn more about Medicare or
Medicare Annual Enrollment, visit
UHCOpenEnrollment.com.
Courtesy BPT