Medicare Part D: the Prescription Drug Program Know the Facts

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Caring Connections Cancer patient, caregiver, and provider resources Medicare Part D: The Prescription Drug Program Know the Facts

Your doctor may prescribe an oral cancer medication for you that may be covered through the Medicare Part D program. To walk you through the program, here is some information about Medicare Part D. What is Medicare Part D?

Medicare Part D is a government program that provides coverage for prescription drugs, including most oral cancer medications.

Am I eligible for Medicare Part D?

People who already have health insurance through the Medicare program are eligible to enroll in Medicare Part D. Specifically, those who can enroll include: • People age 65 or older • People under age 65 with certain disabilities • People who have end-stage renal disease

How would I enroll in a Medicare Part D plan?

Many different Medicare Part D plans are available, and there are resources to help you choose a plan for your prescription drug coverage. You can contact Medicare to find resources for choosing and enrolling in a plan by:

Calling 1-800-MEDICARE Going online to (1-800-633-4227) 24 hours www.medicare.gov a day, 7 days a week

When can I sign up for Medicare Part D?

If you are eligible for Medicare Part D but you are not currently enrolled, you can sign up for a plan at any time. However, if you are eligible and do not enroll in a plan during the open enrollment period, you may face a late enrollment penalty. Costs and coverage for Medicare Part D plans may change from year to year. Because of this, it is important that you review your plan materials each year to make sure that you are satisfied with your plan and enrolled in the plan that is most appropriate for you. If you are enrolled and satisfied with your plan, you do not need to re-enroll every year. Caring Connections Cancer patient, caregiver, and provider resources

Can Medicare Part D plans be changed during the year?

People who are dual-eligible (ie, those who receive both Medicare and Medicaid benefits) can switch plans any time during the year. People who enroll in the standard Medicare Part D plan, however, cannot switch plans after the enrollment period.

What types of plans are available for Medicare Part D?

Medicare Part D drug plans are approved and regulated by the government, and they are administered (in other words, operated and run) by private health insurance companies.

Specifically, there are 2 types of Medicare Part D plans

Prescription Drug Plan (PDP) Medicare Advantage Prescription Drug Plan (MA-PDP)

What is a PDP?

A PDP provides benefits for drugs that are typically obtained at a pharmacy or specialty pharmacy for people with traditional Medicare.

What is an MA-PDP?

An MA-PDP is a managed care plan that offers coverage for Medicare Parts A, B, and D. MA-PDP drug coverage may be the same as the standard Medicare Part D benefit. Other times, the MA-PDP benefits may have a lower cost-share and do not have a coverage gap.

What are the Medicare Part D benefit options?

Medicare Part D includes 3 benefit options:

Standard benefit Enhanced benefit Low-income subsidy Provides basic drug coverage Provides additional coverage (LIS) benefit compared to the standard Provides either a full or benefit partial subsidy for people below 150% of the federal poverty level (FPL) Caring Connections Cancer patient, caregiver, and provider resources

What are Medicare Part D out-of-pocket costs?

Medicare Part D has a deductible phase where you will have to pay all drug costs until that deductible is met. After that, you will pay 25% of drug costs during the initial coverage period and coverage gap until you reach the catastrophic coverage period.

Here is a helpful example of how Medicare Part D may cover your oral cancer medication in 2020: $0–$435 $435–$4,020 $4,020–$9,038.75 $9,038.75+

INITIAL CATASTROPHIC DEDUCTIBLE COVERAGE COVERAGE GAP COVERAGE PERIOD PERIOD

You must pay the You pay 25% of your You pay 25% of your You pay the greater of 5% $435 deductible total medication costs total medication costs of your total medication before your plan between $435 and until the costs reach costs, or $3.60 for begins to pay $4,020 $9,038.75 generics and $8.95 for brands, if your total Your plan pays the Your plan and the drug medication costs are remaining medication manufacturer pay the more than $9,038.75 cost remaining medication cost Your plan and the drug manufacturer pay the remaining medication cost What updates can I expect for my 2021 Standard Medicare Part D Benefit?

• Your deductible is expected to increase to $445 • The initial coverage period range will be $445 - $4,130 • In the initial coverage period and the coverage gap, you will pay 25% of your total medication costs until the costs reach $9,313.75 out-of-pocket • In the catastrophic coverage phase, you will pay the greater of 5% of your total medication costs or $3.70 for generics and $9.20 for brands

What is LIS?

Low Income Subsidy (LIS), or extra help, is available to Medicare patients with limited income and resources. The extra help is paid by the federal government to Medicare Part D plans for costs that include premiums, deductibles, and cost-share.

Do I qualify for LIS?

• Full LIS support may be available to those with incomes less than 135% of the Federal Poverty Line (FPL) • Partial LIS support may be available to those with incomes less than 150% of the FPL but more than 135% of the FPL