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Sample Answer 

Medicare

Medicare Part D

  1. What are the annual premiums for Part D coverage in 2019 and 2020?

Part D monthly premium varies by plan. The average national premium in 2020 is $32.74. This compounds to $392.88 annually. The 2021 Part D base beneficiary premium is $33.06, a modest (1%) increase from 2020. This sums up to $396.72 annually. Actual premiums paid by Part D enrollees vary considerably. Higher-income consumers may pay more Part D premiums. Part D enrollees with higher incomes ($87,000/individual; $174,000/couple) pay an income-related premium surcharge, ranging from $12.32 to $77.14 per month in 2021 (depending on income).

  1. What is the deductible for Part D coverage in 2019 and 2020?

Deductibles can vary from plan to plan, and some plans might offer a $0 deductible. Medicare sets a limit on the deductible for prescription drug plans, which means plans cannot charge you more than the limit. In 2020, the deductible was $435. The standard deductible is increasing from $435 in 2020 to $445 in 2021.

  1. Who is eligible for “Epic”?

The EPIC provides seniors with co-payment assistance for Medicare Part D-covered prescription drugs after any Part D deductible is met. EPIC also covers many Medicare Part D excluded drugs. A resident of New York State who is 65 or older with an annual income up to $35,000 for singles or $50,000 for married is eligible to apply. An eligible senior with a “Medicaid Spend Down” not receiving full Medicaid benefits can also apply.

  1. What drugs are excluded from Part D coverage?

Drugs used to treat anorexia, weight loss, or weight gain are excluded, though Part D may cover drugs used to treat physical wasting caused by AIDS, cancer, or other diseases. Other drugs excluded include Fertility drugs, drugs used for cosmetic purposes or hair growth, drugs used to treat erectile dysfunction, drugs that are only for the relief of cold or cough symptoms, prescription vitamins and minerals (except prenatal vitamins and fluoride preparations), and non-prescription drugs (over-the-counter drugs). Prescription drugs used for the above conditions may be covered if they are being prescribed to treat other conditions as long as the U.S. FDA approves it for such treatment.

  1. What drugs are protected categories?

Six drug classes fall under the protected category. They include anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. The antineoplastics category includes many oral chemotherapy drugs.

  1. How do you describe the “donut hole” and the proposed solution to fix it?

The donut hole is a coverage gap that may temporarily limit what Medicare Part D covers. One enters the donut when the total drug cost reaches a certain limit. The limit was $4,020 in 2020. While in the coverage gap, you are responsible for a percentage of the cost of your drugs. In 2020, the donut hole will close. This means that when you reach the coverage gap, you are responsible for 25% of the cost of the drugs.

References

An Overview of the Medicare Part D Prescription Drug Benefit (2020, October 14). Retrieved November 12, 2020, from https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/

Medicare costs at a glance. (n.d.). Retrieved November 12, 2020, from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

Medicare Prescription Drug Coverage (Part D). (n.d.). Retrieved November 12, 2020, from https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d

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Question 


Medicare

  • In the proper assignment folder using YOUR OWN WORDS with grammar checked and good spelling, etc., answer the following questions:
  • Web link in the notes below if you can’t find it.
    1. What are the annual premiums for Part D coverage in 2019 and 2020?
    2. What is the deductible for Part D coverage in 2019 and 2020?
    3. Who is eligible for “Epic”?
    4. What drugs are excluded from Part D coverage?
    5. What drugs are protected categories?
    6. Using your own words, how do you describe the “donut hole” and the proposed solution to fix it

      Medicare

      Medicare

Website to use: https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance#:~:text=The%20standard%20Part%20B%20premium,higher%20depending%20on%20your%20income).&text=varies%20by%20plan.,for%20specific%20Part%20C%20plans.&text=The%20Part%20D%20monthly%20Premium,income%20consumers%20may%20pay%20more).

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