How will I know what coverage phase I'm in with Medicare Part D?

To determine what coverage phase you are in with Medicare Part D, you can review your Explanation of Benefits (EOB) statement or contact your Medicare Part D plan directly. Your Explanation of Benefits statement will provide a summary of your prescription drug claims and costs, including your current coverage phase. There are four coverage phases in Medicare Part D, which include:

• Deductible phase: During this phase, you pay the full cost of your medications until you meet your plan's annual deductible.
• Initial coverage phase: Once you meet your plan's deductible, you enter the initial coverage phase, where you pay a copayment or coinsurance for each prescription drug you receive, and your plan pays the rest of the cost.
• Coverage gap (donut hole) phase: If you and your plan have spent a certain amount on prescription drugs during the year, you may enter the coverage gap, where you pay a higher percentage of the cost of your prescription drugs until you reach the out-of-pocket threshold.
• Catastrophic coverage phase: Once you reach the out-of-pocket threshold, you enter the catastrophic coverage phase, where you pay a small copayment or coinsurance for your prescription drugs for the rest of the year.

You can add your insulin products to your prescription list and compare plans using your protected Medicare account. Accurate estimates will be provided in the coverage phase specifics, including the fact that your progression through the Part D coverage phases will be based on the price you would have paid (if above the $35 cap per 30-day period) for a covered insulin product.

If you are unsure about what coverage phase you are in, you can also contact your Medicare Part D plan directly by calling the number on your member ID card or by visiting the plan's website. The plan's customer service representatives can provide you with information about your current coverage phase and answer any questions you may have about your Medicare Part D coverage.

MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further explanation.