When it comes to your health insurance coverage, you have a lot of choices. But did you know that Original Medicare does not cover prescriptions? That’s why a Horizon Medicare Advantage plan gives you the peace of mind that you have prescription coverage. This is also known as Medicare Part D.
It’s important that you understand how prescription drug coverage works, including how much you’ll pay for medicines, so you can get the most from your plan.
There are four stages that make up Part D coverage. These stages determine how much your plan pays and the amount you’ll be responsible to pay out of pocket for your prescription medicines.
Remember to review your Explanation of Benefits statement that’s sent to you each month. Your coverage stage is in section two of the statement.
The dollar amounts included in this video are only examples to help you understand how coverage stages work. Your actual amounts may be different depending on your Horizon Medicare Advantage plan.
The first stage is the Deductible Stage. A deductible is the total amount you must pay out of pocket for your medicines before your insurance begins to pay.
Your deductible must be met each year. Once you meet your deductible, you’ll move into the Initial Coverage Stage. This means you’ll only pay the copayment or coinsurance – depending on the medicine. Your Horizon Medicare Advantage plan will pay the rest of the eligible cost for any covered medicine.
Your total drug cost – what you and your plan have paid for your medicines – add up during the Coverage stage.
Once you meet a specific dollar amount for the year, you’ll move into the Coverage Gap Stage, also known as the donut hole. You generally pay more for medicines during this stage.
So, how do you get there? Let’s take a look at an example of medicine that costs $100. If your copayment is $10 and your plan pays the remaining $90, the total cost of $100 is the amount that goes toward the Coverage Gap Stage. So, if you take more than one medicine, you may reach this stage quickly.
The good news is that during this stage, you only pay a percentage of the cost of the drug.
However, both your monthly premium and the amount paid for medicines not covered by your Horizon Medicare Advantage plan do not count towards the coverage gap total.
Once in the donut hole, you get a 70 percent manufacturer’s discount on covered brand name medicines and your plan pays an additional 5 percent. This means you’ll only have to pay 25 percent of the agreed cost of a brand name medicine. And, you can save more by getting generic medicines.
Once you have paid the maximum out-of-pocket costs set by Medicare, you will move to the Catastrophic Coverage Stage. You’ll then pay less for covered medicines for the rest of the year.
Making sense of Part D can be complicated. We want to make it easy.
At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).
ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).
Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.