Reporte Plan de Farmacia - Pharmacy Plan Report


Pharmacy Plan Report

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Today’s Medicare Program Today’s Medicare program has four parts:

1. Part A—Hospital Insurance—Part A helps pay for inpatient care in a hospital or in a skilled nursing facility (following a hospital stay). It also covers some home health care and hospice care.

2. Part B—Medical Insurance—Part B helps pay for doctors’ services and many other medical services and supplies that are not covered by Part A.

3. Part C—Medicare Advantage—Part C, formerly known as Medicare+Choice, is now known as Medicare Advantage. It is a managed care approach to delivering Medicare-covered services, available in many areas. People with Medicare Parts A and B can choose to receive all of their health-care services through a Medicare Advantage provider organization under Part C.

4. Part D—Prescription Drug Coverage—Part D is the prescription drug benefit that helps pay for medications doctors prescribe for treatment.

Part D—Medicare Prescription Drug Coverage
Part D Prescription Drug coverage arose from the passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, otherwise known as the Medicare Modernization Act, or MMA. Anyone who has Medicare Part A, Part B, or a Medicare Advantage plan is eligible for prescription drug coverage under Part D. Joining a Medicare Prescription Drug plan is voluntary, and an additional monthly premium is required for the coverage. Part D is considered by most as very complex.
In 2006, the prescription drug benefit began. Everyone covered by Medicare must make choices with respect to Part D. Beneficiaries are eligible to
• remain in the traditional Medicare program without participating in the drug benefit;
• remain in the traditional Medicare program and enroll in a stand-alone Part D drug plan; or
• enroll in a private Medicare Advantage plan that offers both Medicare health services and prescription drug coverage.

The amount of the monthly Part D premium is not affected by health status or how many prescriptions a patient needs. As with other parts of the Medicare program, income thresholds are established for benefit eligibility. The actual thresholds will not be given here, because they are subject to change with annual review. Those who choose to take advantage of the drug benefit and have incomes exceeding an annual threshold will pay a small monthly premium, and prescription drug benefits are subject to a deductible.
Medicare covers 75 percent of prescription drug costs after the deductible has been met, but only up to a stated maximum. From this point to another threshold, Medicare payments are suspended and beneficiaries pay 100 percent of their drug costs. (This gap is known as the donut hole.) At that point, Medicare covers 95 percent of the costs of prescription drugs. Beneficiaries must pay a co-pay (approximately $2 for generic drugs and $5 for brand names). Co-pays are waived for patients in nursing homes.
Those with very low incomes and minimal assets pay no premiums or deductibles, nor do they experience gaps in their coverage. They are, however, required to pay $2 for generics and $5 for brand names.
Part D drug plans are operated by private companies, and they are all a little different. However, they must all meet standards set by the federal government. Those who do not enroll in a Medicare drug plan when first eligible and have a continuous period of 63 days or more without creditable prescription drug coverage may have to pay a late enrollment penalty upon enrollment. In addition, the premium cost will go up 1 percent of the current year’s national average premium for every full month the individual was eligible to join but did not.

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