*We are not affiliated with or connected with *Medicare or any other government program or agency.
Medicare Part D: Prescription Drug Coverage
Medicare Part D, established through the *Medicare Prescription Drug, Improvement, and Modernization Act of 2003,” provides prescription drug coverage for *Medicare beneficiaries. It was officially implemented on January 1, 2006, and aims to assist beneficiaries in covering the costs of their prescription medications.
➔ Implemented on January 1, 2006
➔ Provides extensive prescription drug coverage
➔ Established through specific legislation
Understanding Drug Formularies Medicare Part D
A drug formulary is a list that encompasses the drugs covered by *Medicare drug plans and Medicare Advantage plans with prescription drug coverage. These formularies must adhere to certain guidelines, ensuring they cover a wide array of prescription drugs, including those used to treat critical and common conditions like cancer and HIV/AIDS.
➔ Drug formularies include both brand name and generic drugs
➔ Must cover a wide range of prescription drugs
➔ Include drugs in protected classes, such as cancer and HIV/AIDS medications
Drug Tiers and Costs
A drug formulary is a list that encompasses the drugs covered by *Medicare drug plans and Medicare Advantage plans with prescription drug coverage. These formularies must adhere to certain guidelines, ensuring they cover a wide array of prescription drugs, including those used to treat critical and common conditions like cancer and HIV/AIDS.
➔ Drug formularies include both brand name and generic drugs
➔ Must cover a wide range of prescription drugs
➔ Include drugs in protected classes, such as cancer and HIV/AIDS medications. LEARN MORE
Changes and Notifications in Drug Plans
*Medicare drug plans can alter the drugs they offer during the year, provided they follow *Medicare guidelines. Such changes can be influenced by various factors, including therapy changes, the release of new drugs, or the availability of new medical information.
➔ Drug plans can change throughout the year
➔ Changes must adhere to *Medicare guidelines
➔ Adequate notification must be provided for any changes
Formulary Exceptions and Changes
If a drug plan alters its offerings, especially concerning drugs you are currently taking, they must provide sufficient notification and a transition period to ensure you are not left without necessary medication. In certain situations, a formulary exception, which is a request to the plan to continue providing your drugs due to medical necessity, can be completed by your doctor.
➔ Sufficient notification must be provided for drug changes
➔ A transition period must be provided
➔ Formulary exceptions can be requested for medical necessity
Acquiring Medicare Drug Coverage
*Medicare prescription drug coverage can be obtained in two primary ways: through *Medicare prescription drug plans (PDPs) or Medicare Advantage Plans (Part C). Both options have specific eligibility requirements and provide varying degrees of coverage.
➔ Two main ways to obtain drug coverage: PDPs and Medicare Advantage Plans
➔ Each option has specific eligibility requirements
➔ Coverage details can vary between options LEARN MORE
“Get Help Enrolling in a Medicare Advantage Plan from a Licensed Sales Agent”
[We do not offer every plan available in you’re area. Currently we represent [x]organizations which offer [xxxx] products in your area. Please contact Medicare.gov, [1-800-MEDICARE], or your local State Health Insurance Program (SHIP) to get information on all of your options. [[Senior Healthcare Advisors, LLC,], [in California – SCH Insurance Agency]] represents Medicare Advantage [HMO, PPO and PFFS] organizations [and stand-alone PDP prescription drug plans] that have a Medicare contract.] [Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved [groceries] [and] [utilities]. Unused amounts will expire at the end of the month or quarter. Enrollment depends on the plan’s contract renewal.
Not all plans offer all of these benefits. Benefits may vary[The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.]
[The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan’s Evidence of Coverage.]
[Part B Premium giveback is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower.
Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.] by carrier and location. Limitations and exclusions may apply.]
[[[Senior Healthcare Advisors, LLC, ], [in California – SCH Insurance Agency]] not connected/endorsed by a government entity.
You also agree to the Terms, Privacy Policy.]] [Part B Premium giveback is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.]
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