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Medigap Plan D – Prescription Drug Coverage
In 2006, Medigap Plan D prescription drug benefits were offered to Medicare participants. During open enrollment, private insurance companies that have contracted with the government will enroll participants in Medigap Plan D, known also as Medicare Part D, prescription drug coverage. Plan D helps pay current outpatient prescriptions and for medication that is prescribed in the future.
With Medigap Plan D a monthly premium is paid as well as a share of the cost of the prescriptions. Plan D has a standard set of benefits that they must offer that are set by the government. Some plans can offer alternative benefits above the standard however it is important to understand the key differences between Plan D plans before enrolling on one.
The federal government has created a standard set of benefits that Plan D must offer, but plans can offer alternatives above the standard. It is important to understand all of the key differences between Part D plans before you select and enroll in one.
How to Choose Your Own Part D on Medicare.Gov
Costs Associated with Medigap Plan D
The Medigap Plan D Programs help participants with the cost of outpatient prescription drugs. Medigap Plan D has a premium, a different cost-sharing structure, and each offers a different set of drugs that they cover. Plan D covers a majority of drugs that are most commonly needed by Medicare participants.
What Does Medigap Plan D Cover?
Medigap Plan D, Medicare prescription drug plans are required to offer the same standard coverage at a minimum. For 2017 this includes:
Standard Benefit Design Parameters2017Deductible$400.00Initial Coverage Limit for Drug Expenses Paid By the individual and the Part D Plan$3,700.00Out-of-Pocket Threshold Paid by Individual$4,950.00Total Covered Part D Drug Spending before Catastrophic Coverage*$7,425.00Minimum Copayment in Catastrophic Coverage Portion of Benefit for Generic/Preferred Multi-Source Drugs$3.30Copayment in Catastrophic Coverage Portion of Benefit for Other Drugs$8.25* Cost sharing for the catastrophic portion of the benefit is set at the greatest of 5% coinsurance or fixed copayments by CMS, which are shown in the last two rows of this table.Plan D will cover generic and brand-name drugs. Many Plan D prescription drug plans have a list of drugs it will pay for. This list must meet the standard requirements that the government has in place. Individual plans have some flexibility to decide what will go on their formulary and how much participants will pay for each drug
If you need a drug that is not listed, or if one is being removed from the formulary list, participants or their doctors can apply for an extension or appeal the decision to the health plan. The Medigap Plan D plan that is chosen must let enrollees know at least 60 days before they remove the drug from the formulary. The plan can choose to add new drugs as they arrive on the market.
Medigap Plan D can also restrict how participants get their drugs. Some plans may require prior authorization. This requires the physician to demonstrate a medical need before the pharmacist is allowed to dispense the drug. Many times the plan will ask the doctor to try a different drug first. Other plans use quantity limits. What this does is place and upper limit on the refills that are allotted.
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