Which vaccines are covered under Medicare Part D?

Part D plans must cover all commercially available vaccines (except those covered by Part B). If there is a new preventive vaccine, it may not appear in the formulary, but the plan may still cover the vaccine. You should contact your plan’s customer service to find out about the specific vaccine.

Vaccines covered by Part B:

  • Hepatitis B (If you’re at high or medium risk of contracting the disease)
  • Influenza
  • Pneumonia

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Are there ways to avoid the Coverage Gap?

There are ways to effectively delay reaching the Coverage Gap or “donut hole.” You enter the Coverage Gap when your total prescription costs (your deductible and copayments in the initial coverage stage plus what the plan pays) exceed the amount set by Medicare each year. The best way to delay reaching the gap is to keep your pharmacy costs down. Here are some ways you can do this:

  • Use generic medications when available and appropriate for you. Generics cost a fraction of the price of their brand-name counterparts, and many Medicare Part D prescription drug plans (PDP) offer $0 or low copayments when you use a generic medication. Talk to your doctor or call your plan and ask for help in finding lower-cost alternatives for your brand-name medications.
  • Take advantage of a home delivery pharmacy for your long-term medications and use a preferred pharmacy when possible. Choosing a preferred pharmacy helps to lower your costs.

 

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What is Medicare Supplement Insurance?

Medicare Supplement Insurance, also called Medigap, are plans offered by private companies that help cover some costs not paid by Original Medicare (such as deductibles and copayments). There are 10 supplemental plans that offer a variety of additional options. Get more information on choosing the right Medicare plan here.

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My employer is no longer providing retiree prescription drug benefits. What should I do?

While losing coverage can be discouraging and stressful, there are many affordable options available under Medicare that may provide you with coverage that better suits your needs and saves you money. Your employer may also offer a broker service to help you with choosing a plan. Keep in mind that if have a Health Reimbursement Account (an HRA) with your employer you should find out what you need to do so you don’t lose it.

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What is the Part D Coverage Gap (“donut hole”)?

In a Medicare Part D plan, Stage 3 is called the Coverage Gap or the “Donut Hole.” You enter this stage after you and your drug plan together have spent an amount set by Medicare for your covered drugs. You continue in this stage until your out-of-pocket costs reach another amount set by Medicare. This amount includes your deductible, coinsurance and copayments in the Initial Coverage stage, the manufacturer’s discount you get on covered brand-name drugs in the Gap; and what you pay for medications while in the Gap. To learn more about the stages of Medicare Part D here.

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