How Does The Medicare Plan D Apply To Mesothelioma Patients?

The Part D drug benefit is prescription drug coverage for people with Medicare. Medicare offers Part D to everyone with Medicare. (People enrolled in Medicare are called Medicare beneficiaries.) Part D coverage may help you lower your prescription drug costs and help protect you from higher costs in the future. It can give you greater access to the anti cancer drugs you need to treat your cancer . To get Medicare Part D drug coverage, you must join a plan that is run by an insurance company or other private company that has been approved by Medicare.

If you join a Medicare drug plan, you usually pay a monthly premium. If you decide not to join a Medicare drug plan when you are first eligible (able to join), you may pay a penalty if you decide to join later. If your income and resources are limited, you might qualify for extra help paying Part D costs.

There are different plans that vary in cost and the type of drugs that are covered by each plan and it is hard to compare them. As a mesothelioma cancer patient, your may incur huge annual drug expenses , so it is important to look at each plan's coverage, as well as your cost-sharing obligations during coverage gaps. Coverage gaps are dollar limits that, when reached, leave you responsible for some or all of the drug costs

The coverage gap or "donut hole" is the gap in which you must pay 100% of your prescription costs. Once your total drug costs (what you and the plan pay for your prescriptions) reach a pre-set dollar amount for the year, you will hit the "donut hole." Then you will pay all of your drug costs until the total out-of-pocket costs reaches another pre-set amount. Reaching this amount triggers what is called catastrophic coverage. After that, Medicare Part D will cover 95% of your drug costs and you will pay a flat co-pay or 5% of the cost of the drug for the rest of that year. (Keep in mind that some cancer drugs cost a lot and 5% can be several hundred dollars a month.)

If your drug plan has a coverage gap , here are some ways you can avoid or delay entering the gap, and save money on drug costs while in the gap:

-See if you can switch to generic drugs or other lower-cost drugs.

-Ask your doctor about drugs that would work just as well as the ones you’re taking now. Even though many cancer treatment drugs do not have generics, the savings in non-cancer drugs may be enough to help you avoid the coverage gap.

You can find out more about saving money by using mail-order pharmacies, generic, or less-expensive brand-name drugs from the Compare Medicare Prescription Drug Plans section of medicare

Keep using your Medicare drug plan card, even if your drug expenses get up to your coverage gap. Using your drug plan card ensures that you’ll get the drug plan’s discounted rates and that the money you spend counts toward your catastrophic coverage.

For mesothelioma cancer patients, this new benefit covers some drugs that were not covered in the past. Before Medicare Part D, Medicare covered only those prescription drugs given as injections in doctors' offices or treatment centers. That included many cancer drugs. Coverage of these cancer drugs will continue under Medicare, while the new Part D coverage will help pay for the anti cancer drugs that are prescribed for you at the local pharmacy.

The new Part D drug benefit is good news for Medicare beneficiaries who have been diagnosed with cancer, especially those who do not have any other way to pay for their prescriptions. Medicare Part D drug plans must accept all who apply and are eligible – no matter their age or health status. Still, the coverage under this benefit does have some gaps that require out-of-pocket spending. And, not every drug on the market will be covered by every Medicare-approved drug plan. It is very important that you carefully review your drug plan options and compare the plan's covered drugs to the drugs you take. Keep in mind that the plan can change, and you will need to be abreast of new developments every year.

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