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Medicare Part D | All You Need to Know About its Coverage

A Brief Overview of Medicare 

Medicare is the federal health care insurance program primarily for those of retirement age. The program was signed into law in 1965 and today covers over 60 million Americans. Medicare is divided into four parts—Part A, Part B, Part C, and Part D. In this article we will cover information about Medicare Part D. 

What is Medicare Part D?

Medicare Part D, also known as Medicare prescription drug coverage, is an optional program to help you cover the cost of prescription drugs. The Medicare prescription drug plan (PDP) was officially enacted in 2003 under the Medicare Modernization Act and went into effect on January 1, 2006. Under this act, Medicare Part D provided prescription drug coverage through private companies to Medicare beneficiaries.

What Does Medicare Part D Coverage Entail?

There are a variety of plans to choose from under Medicare D. Each plan offering has their own list of covered drugs. This list of drugs is called a formulary. A formulary includes both brand-name prescription drugs and generic drugs. All plans must cover at least two drugs per drug category. 

Using the drugs listed on the plan will save you money because the insurance coverage provider negotiated a lower price. If you choose a drug not listed on your plan you will have to pay full price for the drug instead of a copayment or coinsurance. Generally if your specific drug is not listed on the plan, there will be a comparable alternative available through your coverage. You can also apply for a formulary exception to have your drug approved through your insurance provider.

Each plan’s formulary will list drugs under different tiers. The higher the tier, the more expensive the drug will be to you. A breakdown of Medicare Part D’s cost structure is listed below under copay tiers.

What are the Costs of Medicare Part D Plans?

Medicare will cover a portion of your prescription drug costs. The costs that you cover for prescription drugs is considered your out-of-pocket costs. Your out-of-pocket costs will depend on the following factors:

• The drugs you use
• The plan you choose
• Whether you go to a pharmacy in your plan’s network
• Whether the drugs you use are on your plan’s formulary  
• Whether you get Extra Help paying your Medicare Part D costs

Extra Help is an assistance program to help cover some of the Medicare costs. To qualify for Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

The following are the payments associated with Medicare Part D plans: 

Premium: Your monthly premium will depend on the area in which you live and the plan you choose. When reviewing your premium cost be sure to weigh it against the overall cost per year and the cost of the drugs you take. In other words, a lower monthly premium may or may not be the best choice for you if the other payments are much higher. Weigh all of the options before making a decision. 

Deductible: The deductible is the amount of money you must pay out of pocket before Medicare will cover costs. For example, a $300 deductible means that you will need to pay $300 before your insurance plan covers the remaining costs. A lower deductible may be a good option, however you should also compare the premium and other costs to ensure that it is the best financial fit for your situation.

Copay: A copay is a fixed dollar amount for your prescriptions. For example, you may have to pay $10 for a generic drug and Medicare will cost the remainder of the costs. 

Copay tiers: Each Medicare Part D plan places drugs in different tiers. These tiers determine how much your copay amount will be for each drug. The lower the tier, the lower the cost will be to you. Generic drugs are typically labeled as Tier 1 drugs.

Tier Type	Tier 1	Tier 2	Tier 3	Tier 4	Tier 5
Drug Type	Preferred Generic Drugs	Non-PreferredGeneric Drugs	Preferred Generic and Brand Name Drugs	Non-Preferred Generic and Brand Name Drugs	Specialty Drugs
Copay Cost	$	$$	$$$	$$$$	$$$$$

Coinsurance: Coinsurance is the percentage of the prescription cost that you are responsible for covering. Typically plans require coinsurance for drugs in higher tiers.  

Coverage gaps: With Medicare, there is a threshold where the insurance coverage no longer covers the costs of drugs and you are required to pay out of pocket. The point where Medicare Part D stops paying is called the “donut hole.” The cost between the donut hole and catastrophic coverage is known as the coverage gap, and a percentage of it will need to be covered by you. This year, it is expected that you will not have to pay more than 25% for covered brand-name and generic drugs during the gap. In previous years, the percentage you had to cover was much higher. Now the insurance companies will be responsible for more of the cost.

Catastrophic coverage: In 2020, catastrophic coverage will kick in when your out-of-pocket costs for prescription drugs reaches $6,350. This is an increase from 2019 when the dollar amount was set at $5,100. At this dollar amount, Medicare will cover the majority of the remaining cost of the drugs. The amount you will be responsible for will be under 5%.

Late enrollment penalty: The late enrollment penalty is an amount added to your monthly premium. You may owe this amount if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of the following:

• A Medicare prescription drug plan (Part D)
• A Medicare Advantage plan (Part C) 
• Creditable prescription drug coverage

Should You Consider Medicare Part D?

You may wish to enroll in a Medicare Part D plan if:

• You use prescription drugs on a regular basis
• You think you may need prescription drugs in the future
• You do not have prescription drug coverage
• You are worried about increasing prescription drug costs
• You are having trouble paying for your prescription drugs

How To Enroll In Medicare Part D

In order to enroll, you must be eligible for Medicare. You are eligible for Medicare if you meet one of the following qualifications:

• You are age 65 or older
• You have a qualifying disability for which you have been receiving Social Security Disability Insurance (SSDI) for more than 24 months
• You have been diagnosed with end-stage renal disease
• You are entitled to Medicare Part A and/or enrolled in Medicare Part B

The Initial Enrollment Period is a seven-month timeframe that begins three months before the month you turn 65 and ends three months afterward. During this period you can enroll into Medicare Part D. If you miss the initial enrollment period then you can sign up during the general enrollment period which runs every year from January 1-March 31.

Once you are eligible, the first step to enrolling is to review the private plan offers available in your location. You can call 1-800-MEDICARE or visit the Medicare’s Plan Finder tool on medicare.gov to compare plans and enroll. To learn about Medicare Advantage, Supplement, and Prescription Drug plans, request a free quote.

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Mutual Of Omaha Medicare Plans

A Mutual of Omaha® Medicare plan is a great option if you’re looking for additional Medicare coverage to meet your healthcare needs. Founded in 1909, Mutual of Omaha was one of the first carriers to offer supplemental Medicare insurance to consumers. As of January 2019, A.M. Best Rating Services gave Mutual of Omaha an A+ (Superior) rating. 

Medicare Part A (hospital) and Part B (medical insurance), also known as Original Medicare, only covers about 80% of medical costs and doesn’t include a prescription drug plan. Without a more comprehensive health insurance plan through a private insurer like Mutual of Omaha, you could end up paying a lot of your healthcare costs out-of-pocket. 

In this article we will discuss the types of Medicare plans offered by Mutual of Omaha:

• Mutual of Omaha Medicare Supplement Insurance Plans
• Mutual of Omaha Medicare Advantage Plans
• Mutual of Omaha Medicare Part D Prescription Drug Plans
• How to Enroll In a Mutual of Omaha Medicare Plan

Mutual of Omaha Supplement Insurance Plans

Although a Mutual of Omaha Medicare Advantage plan offers comprehensive benefits, you might prefer to remain enrolled in Original Medicare. If so, consider enrolling in a Mutual of Omaha Medicare Supplement insurance plan, also known as a Medigap plan, to work alongside Original Medicare. 

As one of the first insurance companies to offer Medicare Supplement or Medigap plans, Mutual of Omaha now offers a variety of plan options with benefits that include: 

• Lower Out-of-Pocket Expenses. Medicare Supplement plans pay some of the costs that Original Medicare doesn’t, such as copays, coinsurance, and deductibles. 
• No Referrals Needed to See a Specialist. You can see any doctor without a referral, including specialists, as long as the provider accepts Medicare. And, you don’t need to worry about finding in-network providers with Medicare Supplement.
• Nationwide Coverage. You can use your plan anywhere Medicare is accepted, including outside your home state and outside the country. 
• Guaranteed Renewable. Your plan can never be canceled, as long as you continue to pay your premiums. Also, you can’t be denied for pre-existing health conditions if you apply during open enrollment.

There are 10 standardized Medicare Supplement insurance plans, each with differing amounts of coverage:

Benefits	Plan A	Plan B	Plan C	Plan F	Plan G	Plan K	Plan L	Plan N
Part A Coinsurance and Copay	100%	100%	100%	100%	100%	100%	100%	100%
Part B Coinsurance and Copay	100%	100%	100%	100%	100%	100%	50%	75%
Part A Deductible		100%	100%	100%	100%	50%	75%	100%
Part B Deductible			100%	100%
Blood (first 3 pints per year)	100%	100%	100%	100%	100%	50%	75%	100%
Part B Excess Charges			80%	80%	80%			80%

While the details of plan coverage will vary by state, Mutual of Omaha’s most popular Medicare Supplement plans include: Plan F (may no longer be offered after 2020), Plan G, and Plan N.

Medicare Supplement Part G:

• Offers lower monthly premiums than many other supplement plans
• You pay the Part B deductible
• Increasing in popularity as Plan F is phasing out

Medicare Supplement Part N:

• Often the choice of individuals on a budget, with lower monthly premiums than Part G
• You pay the Part B deductible
• As a tradeoff for lower premiums, you are responsible for some copays ($20 for doctor visits and $50 for emergency room visits)

You can only purchase a Mutual of Omaha Medicare Supplement insurance plan if you have Original Medicare. You cannot combine it with a Medicare Advantage plan. 

Mutual of Omaha Medicare Advantage Plans

A Medicare Advantage plan, also called Medicare Part C provides an alternative to Original Medicare. Medicare Advantage plans replace Medicare Part A and Part B, including all of the same coverage as Original Medicare while offering additional benefits, too. 

Mutual of Omaha Medicare Advantage plans include the following all-in-one coverage and benefits:

• Medicare Part D Prescription Drug Coverage. One feature that separates Mutual of Omaha’s Medicare Advantage plans from Original Medicare is that they include a Medicare Part D prescription drug plan. Many Medicare Advantage plans have coverage for prescription medication—generic and brand. With a Mutual of Omaha Medicare Advantage plan, you’ll have a low copay for medications, helping you save money.
• Dental Coverage. Along with regular doctor visits, Mutual of Omaha’s Medicare Advantage plans include dental benefits. This coverage extends beyond basic coverage to protect your teeth and gums. 
• Vision Coverage. You’ll receive coverage for routine eye examinations, contact lenses, and eyeglasses and no extra charge.
• No Copays for Lab Tests. Copays and coinsurance for lab tests can be expensive. So you may delay scheduling a recommended test. When you sign up for Mutual of Omaha’s Medicare Advantage plan, you won’t pay a copay for most labs or tests.
• Free Enrollment in the Silver Sneakers Fitness Program. Being physically active is an excellent way to maintain a healthy weight and heart. Through Mutual of Omaha’s Medicare Advantage plans, you’ll receive a free gym membership.
• Medical Transportation Benefit. Mutual of Omaha’s Medicare Advantage plans include a transportation benefit to cover the cost of travel to doctor appointments. Depending on your diagnosis or condition, it may also cover non-emergency ambulance service to and from your doctor.
• Over-the-Counter Allowance. Each quarter, Mutual of Omaha’s Medicare Advantage plans provide an allowance for over-the-counter health-related items. Covered items range from bandages to non-prescription medications.

Mutual of Omaha Medicare Part D Prescription Drug Plans

If you’re enrolled in Original Medicare and need prescription drug coverage, you can sign up for stand-alone Medicare Part D prescription drug coverage through Mutual of Omaha. 

Working alongside your Original Medicare and/or Medicare Supplement plan, Mutual of Omaha’s Part D plans offer the following benefits:

• Reduced out-of-pocket costs for generic and brand prescription medications. 
• Low monthly premiums.
• Low copays on commonly prescribed drugs.
• Low deductibles.
• Preferred pricing at more than 24,000 pharmacies nationwide.

How To Enroll In A Mutual of Omaha Medicare Plan

Mutual of Omaha has provided financial solutions and insurance protection since 1909. Whether you’re looking for a Medicare Advantage plan or Medicare Supplement insurance, this company offers several options for reducing your out-of-pocket costs and increasing your available benefits. 

To be eligible for Medicare, and a Mutual of Omaha Medicare plan, you must be 65 and enrolled in Original Medicare. The initial open enrollment period for Medicare Advantage and Medicare Part D begins three months before your 65th birthday and ends three months after your 65th birthday. 

To enroll at a later time (or switch plans), open enrollment occurs each year from October 15 to December 7. If you enroll during the annual open enrollment, your coverage doesn’t begin until January 1.

If you’re thinking about enrolling in a Mutual of Omaha Supplement insurance plan, you must first enroll in Original Medicare. Also, you must sign up for Medicare Supplement insurance during the six-month window starting the month you turn 65, to avoid medical underwriting.

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