If you have car insurance, you should be familiar with how a deductible works.
This is the amount that comes out of your pocket for either health care or prescriptions BEFORE your insurance kicks in. Think of it as a "delayed start" by your insurance company. Each year, you must pay for doctors, clinics, prescriptions, and other health care on your own until you spend as much as the annual deductible. (We have seen policies with deductibles in the $350 range, but it could be much higher or lower, or even zero.) After you've paid for services equal to your deductible, any future expenses fall under the terms of your insurance.
It's a general rule that the higher the deductible, the lower the premium for insurance. You probably will find you can choose between multiple policies with different deductibles. Don't forget: it starts all over with each New Year. Get more info at: What Is A Deductible in Medicare Insurance?
Annual Enrollment Period
Actually, it's the Open Annual Enrollment Period, which is the period between October 15 and December 7. The rules say that for most people, this is the only time you can sign-up for Part D Prescription Drug insurance plans. It also applies to people who already have coverage, but want to switch to a new company or policy.
There are exceptions. See: Joining, switching and leaving a Medicare Part D plan. You can switch to a 5-Star Part D plan at any time between December 8 and November 30 for the 2015 year. What is a 5-Star Part D Plan?
Copayment (sometimes "Co-pays, or Drug Co-Pay")
Many Medicare insurance policies require you to pay a set portion of the costs when you see a doctor or get a prescription. It's usually a set amount, like $10 or $20 dollars, instead of a percentage.
Estimated Annual Cost (and Estimated Annual Drug Cost)
These are terms you'll see as the heading for a column when you use the "find a plan" tool at medicare.gov. The Estimated Annual Cost is Medicare's estimate of the amount you will spend each year for health coverage. It includes the plan coverage, plus costs for premiums, copayments, deductibles and coinsurance, and expenses that are not covered by your insurance.
The Estimated Annual Drug Cost is similar, except that it is used when you compare Medicare Part D prescription drug insurance plans. This is the amount Medicare estimates you will pay each year for your prescriptions, including the monthly premium, your deductible (if any), your co-payments, and the price of any drug that is not covered by your insurance. If you entered your prescriptions into the Medicare Plan Finder, then this estimate includes the cost of those drugs. If you chose "I don't take any drugs," than the Estimated amount is for insurance premiums only, since you would have no drugs to include in the list. If you entered "I don't want to add drugs now," when you used the Plan Finder, then the amount includes Medicare's average drug costs for people on Medicare of your age and health status.
You might be surprised to learn that the prescription drugs which insurers agree to cover is different from company to company. In other words, if you regularly use a prescription for "something-drug", you will find Insurance Company A includes it in their coverage, but Insurance Company B does not. If it's not on the formulary list, it's probably not covered.
The list of drugs that each plan covers is called the Formulary. You can review it before buying a policy, and we think you should if you are taking any fairly expensive prescriptions. More at: The Medicare Formulary Explained in Plain Text
The "Plan Results" page for Part D plans at "find a plan" at medicare.gov use a star rating that shows how the plan performs. Ratings go from 1 star (poor quality) to 5 stars (excellent) More at: What is a 5-Star Part D Plan?
Your insurance company classifies the drugs in their formulary by placing them into "tiers". What you pay each time you order that drug depends on what tier it is in. Usually tier 1 drugs are the cheapest, and many generic drugs are Tier 1 drugs. Tiers 2 and 3 are usually brand name drugs, and each tier higher means you'll pay more for that prescription. More at:An Introduction to a Part D Formulary
Why this website?
We are a family of senior adults, with all the health issues of the average older American. Medicare has been a factor in our lives, as it is for millions of people like us. This website exists to offer plain talk, simple introductions to the maze of details that make up the Medicare program.
We aren't experts- we'll leave that to the real experts-- for the more complicated rules and issues of Medicare. What you'll find here is a beginning point. A start in your Medicare journey.
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Look for a section named "Definitions" that begins on page 141.You should have received a copy of 'Medicare & You 2015' in the mail. If you don't have your copy, call 800-803-7174. Download a pdf version.
"Medicare terminology can be confusing. But with so many options while choosing your coverage, it's important to understand what each means. Here are some terms you should know...""
From The Detroit Free Press October 16, 2014