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Are your medications in your plan formulary? Are your doctors in your plan network?
These are the two most critical questions to ask when selecting a health insurance plan. We can help! Click here for a check up.
Rx Drug & Provider Checkup for Maine
We at The Vachon Agency, covering Scarborough, Cape Elizabeth, Kittery, Portland, Augusta, Bangor, Caribou, Eastport, Rangeley, ME, and all of Maine, know how important it is for you to have access to the best prescription medications and medical professionals.
Are your medications in the formulary? Are your doctors in-network? We can help you make wise decisions and take charge of your health. Contact The Vachon Agency
immediately, and we’ll help you identify the best healthcare providers and maximize your Rx drug coverage. We put your health first and are here to help you every step of the way.
Rx Drug & Provider Checkup
Prescription Coverage Varies by Plan. We’re Here to Help You Handle It All.
How prescription drug costs are covered in the individual U65 market, and Medicare is very different! However, one thing remains the same –Always ensure that your prescription drugs are covered under your chosen plan.
Under 65 Individual Health Insurance plans:
Prescription drugs are included in your plan (provided they are in the formulary) and count toward your Maximum Out-Of-Pocket (MOOP) cap.
Medicare Prescription Drug Coverage—Part D.
Prescription drug coverage in Medicare has no annual maximum out-of-pocket (MOOP) cap. When shopping for a Medicare Prescription drug plan—whether it is a standalone plan or included in your Medicare Advantage Plan, utilizing Prescription RX Checkup is highly recommended!
Medicare supplement (Medigap) plans do not include prescription drug coverage. If you have a Medicare Supplement (Medigap) plan, it is recommended, but not required, that you also pick up a standalone prescription drug plan or Part D.
Accident Supplement Insurance:
More About Rx Drug & Provider Checkup
More About Medicare Prescription Drug Plans. We’re Here to Help You.
Part D was implemented in 2006 with the passage of the Medicare Modernization Act (MMA) authorized by Congress in 2003. This helps Medicare beneficiaries pay for self-administered medications, and plans are offered through private health insurance companies.
Though technically optional, enrolling in a plan is in your best interest when you first become eligible for Medicare. If you delay Enrollment, you will be penalized 1% of the national average cost of a prescription drug plan (approx. $33/month) for every month they were eligible for this coverage but chose not to have it.
If/when you enroll in a prescription drug plan (PDP), the penalty will be added to your monthly premium for the plan for the rest of your life.
Rx Drug & Provider Checkup Continued
Stages of Coverage for Medicare Part D plans. We’re Here to Help You Make Informed Choices.
The four stages of RX for Medicare change in 2024:
There are four stages to Part D drug coverage, which runs on a calendar year:
- Stage 1: Deductible
- The amount you pay before your plan covers some of your prescription drug costs.
- Stage 2: Initial Coverage
- During this stage, you and the plan cost-share the cost of your medications. You remain in the stage until $5,030 has been paid between you and the plan. Note: Most people remain in this phase for the entire year.
- Stage 3: Coverage Gap
- Otherwise known as the “donut hole.” You enter this stage after reaching the $4,430 Initial Coverage phase. This is the stage where you will pay the most for your prescription drugs – 25% of the cost of generic and brand medications. You remain in this phase until your out-of-pocket costs for the year reach $8,000.
- Stage 4: Catastrophic Coverage
- · After reaching $8,000 your costs will be $0 the remainder of the calendar year. You will be responsible for paying $3.95 for generic medications $9.85 for brand medications – or 5% (whichever is more) until the end of the year.
Need help paying for prescription medications?
Several public and private assistance programs are available for people who face high prescription drug prices.
Need help paying for prescription medications?
Extra Help is a federal program for low-income Medicare beneficiaries. Depending on your income and resources, eligible beneficiaries can get help to lower monthly premiums, deductibles, and co-payments.
