People with Medicare may enroll in Part D coverage through either a stand-alone plan or a Medicare Advantage plan. People on Medicare who choose not to enroll and have no other drug coverage may pay more for late enrollment.
- October Announcement of Part C and Part D plans for the upcoming year. Visit www.medicare.gov to compare plans Medicare open enrollment begins October 15
- December Medicare open enrollment ends December 7
- January New plans and plan changes take effect January 1
What Are My Medicare Options?
Original Medicare Part A Hospital | Part B Medical + Medicare Supplement + Prescription Drug Coverage
- Original Medicare Part A Hospital and Part B Medical: Fee-for-service coverage under which the government pays your health care providers directly for your Part A and/or Part B benefits.
- Medicare Supplement (secondary insurance): Sold by private insurance companies to fill “gaps” in Original Medicare coverage. Others may have coverage through a retirement health plan or Medicaid.
- Prescription Drug Coverage: Sold by private insurance companies to fill “gaps” in Original Medicare coverage. Others may have coverage through a retirement health plan or Medicaid.
Medicare Advantage Plans (HMOs and PPOs Part C)
Offered by private companies that contract with Medicare to provide Part A and Part B benefits. Plan types include health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service plans and more. These plans take the place of Original Medicare and most include the Part D prescription drug benefit.
What Is Medicare Part D?
Part D is Medicare’s comprehensive prescription drug coverage benefit and is available to anyone eligible for Medicare Part A or Part B. People with Medicare may enroll in Part D coverage through either a stand-alone plan or a Medicare Advantage plan. People on Medicare who choose not to enroll and have no other drug coverage may pay more for late enrollment.
What Does Part D Cost?
In 2021 the Medicare Part D out-of-pocket costs for consumers are:
- Average Monthly Premiums - $37.00
- Annual Deductible - $0 - $445
- Copays - 25% or flat copay amounts based on formulary.
- Initial Coverage Limit - $4,130
- Out-of-Pocket Threshold - $6,550
- Catastrophic Coverage - $10,313
How Do I Choose A Part D Plan?
Each year you should review your plan options and look for three things:
- Convenience - Know what pharmacies are in network and if the plan has preferred pharmacies
- Cost - Know all possible out of pocket expenses
- Coverage - Make sure all your current prescription medications are included
What Is The Extra Help Program?
Extra Help is a Medicare program that helps people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called low-income subsidy (LIS), if your annual income and total resources are below these limits this year: prescription medications are included:
- Monthly Income $1,630
- Resources $14,790
- Monthly Income $2,198
- Resources $29,520
For help applying for Extra Help benefits, contact the OSHIIP Program at the Ohio Department of Insurance at 1-800-686-1578.
What Counts As Income And Resources?
Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). Resources don’t include your home, car, household items, burial plot, burial expenses (up to $1,500 per person), or life insurance policies. Income includes any money received from social security, pensions, employment, interest and more.
If you qualify for Extra Help, Medicare will pay:
- All or most of the monthly premium
- All or most of the annual deductible
- Most of your copayments/co-insurance
- Full coverage during the donut hole
In 2021, drug costs for most people who qualify will be no more than $3.70 for each generic drug and $9.20 for each brand name drug. Look on the Extra Help letters you get, or contact your plan to find out your exact costs.