KBenefits Insurance Services
Medicare Part D

Medicare Part D Prescription
Star Ratings & Stages of Coverage

Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare provided through private plans that contract with the federal government. Beneficiaries can choose to enroll in either a stand-alone prescription drug plan (PDP) to supplement traditional Medicare or a Medicare Advantage plan, mainly HMOs and PPOs, that provides all Medicare-covered benefits, including prescription drugs (MA-PD).

Part D - Medicare Star Ratings

Medicare's Star Rating System measures the performance of Medicare Advantage and Part D plans.  The Rating System scores how well plans perform in several categories:  quality of care and customer service.  Ratings range from 1.0 to 5.0 stars, with five being the highest and one being the lowest.   You can use the overall star rating to compare performance among several different plans but it's most important to make sure the plan you choose has your prescriptions covered their their formulary list.

 

  • Medicare reviews drug plan performance yearly. 
  • Medicare releases new Part D Prescription - Star Ratings each fall.
  • Visit Medicare.gov for more information.

Part D:  Four Stages of Drug Coverage

Stage 1:  Rx Deductible:
The amount you must pay for health care or prescriptions, before Original Medicare, your Medicare drug plan, your Medicare Health Plan, or your other insurance begins to pay.  For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.

Stage 2:  Initial Rx Coverage Level:
Once you have met your yearly deductible, and until you reach the plan's out-of-pocket maximum, you pay a copayment (a set amount you pay) or coinsurance (a percentage of the total cost) for each covered drug.

Stage 3:  Rx Coverage Gap:
Starting January 1, 2011, if you reach the coverage gap (also called the "donut hole") in your Medicare prescription drug coverage, you will get approximately a 50% discount on covered brand drugs. Medicare has also increased its coverage of generic drugs for beneficiaries in the coverage gap so that beginning in 2011 you will pay less for generic drugs as well. The drugs eligible for the brand discount or the additional generic savings may change based on the information we have available.

Stage 4:  Catastrophic Rx Coverage:

Once you reach your plan's out-of-pocket limit during the coverage gap, you automatically get "catastrophic coverage."  Catastrophic coverage assures that once you have spent up to your plan's out-of-pocket limit for covered drugs, you only pay a small coinsurance amount or a copayment for the rest of the year.
 

Visit Medicare.gov for more information.


KBenefits Insurance Services
Health - Life - Medicare

Christopher S. Kudryk
Insurance Specialist
chris@kbenefits.com
732-333-1976

KBenefits specializes in health, dental, vision, life and medicare insurance for employers and individuals in NJ & NY.

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