As a part of Medicare, Prescription Drug Plans (PDP) are framed by the Center for Medicare & Medicaid Services CMS.gov, an agency of the US Federal Government. CMS created a benchmark plan that incorporates drugs from every class to treat every type of illness. Using this plan as a baseline, private insurance companies have a guide whereby they can offer a list of drugs, known as a formulary, that is better than the baseline, but cannot be below it. This model guarantees a minimum level of service delivery using individual insurance companies because the job was just too big for the federal government alone.
Currently we offer Prescription Drug Plans (PDP) from SilverScript, Humana, Clover, Wellcare & UnitedHealthcare®
To Demystify PDP plans, I have broken out the components then thoroughly explained them to keep each section simple. PDP plans can be purchased from only those private insurance companies approved in each individual state by the Commissioner of Insurance for that state.
There are multiple ways to pay for PDP plans, but in general, a flat monthly cost known as a premium is charged in addition to a copay or cost-sharing based on classes of drugs known as tiers with an annual deductible that must be met. Depending on the plan you purchase, monthly premiums can be deducted directly from your Social Security check.
Because CMS.gov only establishes the baseline plan, insurance companies are able to select whichever drugs for each class that they think works best for them. Since Medicare mandates that every illness must have a medication to treat it, Medicare has made sure that you will always be able to find a particular class of drug that will behave in a way that will treat your specific illness. If you cannot find the specific drug your doctor wants you to take, an appeal process is available.
PDP plans are available on a stand-alone basis, in conjunction with a traditional Medicare Supplement, also known as Medigap, and as part of a Medicare Advantage Plan with Prescription Drug Coverage known as MAPD.
We would be honored to help Demystify the Prescription Drug Program (PDP) aspect of Medicare or any part of Medicare for you by invitation in your home or by Zoom meeting.
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