|Secure Choices Insurance Services
1624 3rd Avenue North
Jacksonville Beach, Florida 32250
(904) 242-0163 Facsimile
Medicare Part D was signed into order by
President George W. Bush in 2003 and
implemented in 1/2006. Medicare offers
prescription drug coverage to everyone . There is a
1% penalty per month for not taking a plan unless
you have creditable coverage through another plan
or you qualify for Extra Help. To get prescription
drug coverage "PDP" you must join a plan
"Insurance Company" that is approved by
Medicare to offer the coverage. It is very
IMPORTANT that you compare plans every year,
because these plans can change and you could be
spending $1000's more by not comparing.
A Medicare Part D plan can be purchased as a stand alone policy or it can
be included in a Medicare Advantage Plan. The Cost of a plan is
determined by the company you choose and your income. Premiums are
between $18.00 and $174.00 per month plus income related charge.
Medicare Part D Benefits
You will Pay a Deductible between $0.00 - $405.00
You will then pay a Co-pay of either a % or $ Amount, this will be
determined by the company in a form of tiers. Tiers are normally 1-5
The higher the Tier the higher the co-pay.
Once the Actual Cost "what you pay and the insurance company pays" of
your prescriptions equals $3,750.00 you will enter the Gap or Donut Hole.
The you will pay 44% of Generics and 35% of Brand name meds.
The Catastrophic Level is when the actual costs reach $5000.00
Then the maximum you will pay is 5% of the cost of the prescription.
IMPORTANT: All Insurance Companies have a formulary - which is a list of
medications the company will cover and what Tiers the medication will be
under. Also they can have 3 requirements:
1. Quantity Limits
2. Prior Authorization
3. Step Therapy
Medicare Part C Benefits: (MA and MAPD Plans)
A Medicare Advantage Plan is another way to get your Medicare coverage.
They are offered by private Insurance Companies that are approved by
Medicare. They are not a Medicare Supplement. If you join a Medicare
Advantage plan you will not be using your Medicare benefits. The plan will
cover your Part A, B and most of the time D benefits as well.
They must cover all of the services that original Medicare covers except
hospice and some care in clinical research studies. Those are options for
Medicare Advantage plans have co-pays and coinsurance and usually a
network of providers to adhere to.
They do offer additional benefits not covered by Medicare such as: Gym
Membership, nursing hot line, transportation, glasses and some routine or
even comprehensive dental depending on the plan.
There are 4 different types of Medicare Advantage Plans:
1. Private Fee for Service (PFFS) no list of doctors but the doctor can accept
the plan from month to month
2.Health Maintenance Organizations(HMO) Referrals required and must
adhere to a list of providers except in emergency situations.
3. Health Maintenance Organizations-Point of Service (HMO-POS) which
do not require referrals.
4.Preferred Provider Organizations(PPO)No referrals required, a list of
providers, but can go outside the list with higher co-pays.
IMPORTANT: These plans also change year to year so it is important to
read your Annual Notice of Change and to compare to make sure you are in
the right plan.
***Call us to Compare your plan at NO COST to you. We are
unbiased and represent 30 different companies so we can
choose the best plan that fits your needs 904-242-8893.
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