Medicare Part D Prescription Drug Plans Flashcards
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Read the first 6 Medicare Part D Prescription Drug Plans flashcards as text
Medicare Part D prescription drug coverage is provided through:
Answer: Private insurers approved by CMS
Part D coverage is delivered by private insurance companies that are approved and contracted with CMS.
What is a formulary in a Medicare Part D plan?
Answer: A list of covered prescription drugs
A formulary is the list of prescription drugs covered by a Part D plan, typically organized into cost-sharing tiers.
What is the Part D late enrollment penalty based on?
Answer: 1% of the national base beneficiary premium for each full month without creditable coverage
The Part D late enrollment penalty is 1% of the national base beneficiary premium multiplied by the number of full months without creditable drug coverage.
The 'coverage gap' (donut hole) in Medicare Part D refers to:
Answer: A temporary limit on drug coverage after total drug costs reach a threshold
The coverage gap is a temporary limit on drug coverage after total drug costs (plan + member) reach a defined threshold, during which the member pays a higher cost-share.
What is 'catastrophic coverage' in Medicare Part D?
Answer: Coverage that begins after very high out-of-pocket drug costs are met
Catastrophic coverage kicks in after a beneficiary's out-of-pocket drug spending reaches the catastrophic threshold, significantly reducing their cost-sharing.
Which program provides Extra Help (Low Income Subsidy) for Medicare Part D costs?
Answer: The Social Security Administration administers the LIS/Extra Help program
The Social Security Administration (SSA) administers the Extra Help/Low Income Subsidy (LIS) program that helps low-income beneficiaries pay Part D costs.