Pharmacy Outreach Program
The University of Rhode Island College Of Pharmacy
Aged 65 years or older 01.
Aged 65 years or less with certain disabilities 02.
All people with end-stage renal disease (ESRD) 03.
All people with Lou Gehrig’s Disease (ALS) 04.
Part A: - Inpatient hospital care
- Skilled nursing facilities (under certain conditions)
Part B:
- Physician services, durable medical equipment, physical therapists, and mental health care services provided by marriage & family therapists and mental health counselors.
- The standard Part B premium for 2025 is $174.70/month (income based). It may be higher for high income households.
- In general, automatically deducted from social security checks
- There is a Part B deductible, once the deductible is paid enrollee generally pays a 20% co-payment for each service
Part C:
- Health insurance coverage, including preventative care PLUS prescription drug coverage in a single plan
- In exchange, typically must use a certain network of doctors, hospitals, and pharmacies (HMO, PPO)
Part D:
- Stand alone prescription coverage
● Stand alone prescription drug coverage
● Open to all people eligible for medicare
● Open Enrollment Period for services beginning 1/01/2025
○ October 15, 2024 to December 7, 2024
● Medicare Part D is VOLUNTARY!!
○ But penalties may apply
● If you did not enroll but were eligible to do so…
○ When you enroll late for coverage you will incur a penalty of a premium increase of 1% per month that you were eligible
○ The penalty amount may change each year, due to changing base premiums
● You will have to wait until next enrollment period to join a Medicare drug plan if don’t do so now!
● You will NOT have this penalty enforced:
○ If you were not previously eligible for Medicare Part D
○ If you previously had creditable coverage
○ Qualify for an extra help program (Medicaid, SSI)
● Creditable Coverage = a plan that provides a prescription drug benefit that is EQUIVALENT or better than Medicare
Part D coverage
● You would have already been made aware of this by your insurance provider by mail
○ **KEEP THIS LETTER IN A SAFE PLACE**
**If you are unsure if your coverage is creditable or not, ask your employer or union for it!**
What if my 65th birthday does not fall within the enrollment window?
7 Month Penalty Free Period ● 3 months before turning 65 ● 1 month during birthday month
3 months after turning 65
If not enrolling within these 7 months, will incur the late enrollment penalty
● If you are happy with your current part D plan, you do NOT have to change anything during the re-enrollment period!
○ Your Med D plan will automatically re-enroll you.
○ But be aware….. your premiums, co-pays, formulary, or deductible may be changed for the new year! Always check to make sure!
Even if keeping your current plan, always check for premium price changes!
People who are enrolled in a Med D plan right now but are thinking about switching to another plan next year
If you didn’t sign up for a plan when eligible last time around but you’re thinking of enrolling now
● Penalty will apply
○ 1% increase in premium for every month not enrolled
Enrolled in a Medicare Advantage Plan or Medigap Supplemental Insurance Plan but you want to add or change your drug coverage
● Step #1: The Deductible
○ You pay 100% and plan pays 0%
○ You pay at most $590 and receive the same worth of medications
● Step #2: Initial Benefit
○ You pay 25%, Medicare Part D pays 65%, manufacturers pay 10%
○ Once total spending hits $2,000 you enter catastrophic coverage
○ *Coverage gap “donut hole” no longer exists
● Step #3: Catastrophic Coverage. NEW!
○ Starting January 1, 2025, once your out-ofpocket spending reaches $2,000, ■ (including certain payments made by other people or entities, including Medicare’s Extra Help program, on your behalf)
■ You won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year
● New payment option to manage your out of pocket drug costs to spread them out across the calendar year.
● This payment option might help you manage your expenses. But, it does NOT help save you money or lower your drug costs.
● Each month, you continue to pay your premium and will get a bill from your health or drug plan to pay for your prescription drugs instead of paying at the pharmacy.
● The Part D Senior Savings Model is available to all people with Medicare.
● Plans that participate in this model will offer coverage choices that include multiple types of insulin at a maximum copayment of $35 for a 30-day supply, even through deductible and initial benefit phases.
○ Each plan differs in what they cover and cost.
● Visit Medicare.gov/plan-compare/ to find a participating plan in your state.
● Non-FDA approved drugs
● Weight loss or gain
● Erectile dysfunction
● Drugs for cosmetic purposes (hair growth)
● Non prescription drugs (over-the-counter medications)
● Cough & cold relief
● Fertility drugs
● Prescription vitamins, minerals ○ Except prenatal vitamins and fluoride preparations
● Ask your doctor about generic and less expensive brand name drugs (therapeutic substitutions)
● Ask your doctor for samples
● Mail order pharmacy
● Use GoodRx internet coupons
● Walmart $4/$10 list
● Pharmaceutical Assistance Programs
○ Available from the pharmaceutical manufacturers
○ Contact the Partnership for Prescription Assistance ■ 1-888-477-2669
● Apply for Extra Help
○ If you have limited income and resources, you may qualify for extra help
○ For more information go to www.socialsecurity.gov or call 1-800-772-1213
● Even though you were enrolled in a program last year, you start from Step #1 all over again on January 1, 2025
● You will continue to pay the premium every month regardless of what step that you are on
● Get a complete list of your medications
○ Include ALL prescriptions: eye drops, creams, inhalers, patches, etc.
● Go to Medicare.gov/plan-compare
○ Follow the prompts and enter your medications
● Can also call 1-800-MEDICARE (1-800-633-4227)
● Can enroll online—have your Medicare card ready
Follow the steps to make an account! OR
Enter your zip code and select Medicare Part D for plan type
Select Medicare Part D and answer the following questions
Make sure to add correct dose and quantity you take!
Once done adding medications it will have you confirm your drug/medication list
Enter the zip code of where you want to pick up your medications and choose your preferred pharmacy from the list
Once this is done a bunch of plans will pop up to choose from
● Cost
○ Will your premium and costs change in 2025?
● Coverage
○ Will you need more comprehensive coverage?
○ Will your current meds be covered by your plan?
● Customer Service
○ Are you satisfied with your service from your current plan?
● Must offer basic/standard drug benefit
○ May offer enhanced benefit
● Some have no deductible
● The Premium depends on the enhancements
● Mail order options may save costs on maintenance medications (90 days)
● No single plan is best for everyone
○ You must pick the plan that’s right for YOU!
○ Make sure to enroll between Oct 15 – Dec 7, 2024
● Yes, it is confusing! Don’t be afraid to ask for help:
○ The Point Resource Center (401) 462-4444 or 211
○ SHIP counselors at your local Senior Center
i. Make an appointment at your Senior Center
○ Dept. of Elderly affairs (401) 462-4000
● Medicare part D must cover all vaccines not covered by part B
○ Ex: Shingrix (Shingles vaccine)
● Vaccines covered by part B
○ Pneumococcal
○ Influenza
○ Hepatitis B
○ COVID-19
○ Vaccines necessary to treat a disease or prevent one after direct exposure
■ Ex: tetanus
● The vast majority of your health care providers are committed to providing you with high quality care.
● However, there are some individuals who cheat the system out of millions of dollars, which results in higher premiums for its members.
○ Be very cautious when dealing with your Medicare information, & never share it unless you are absolutely certain that they need it.
○ Never share your Medicare information over the phone with someone else!
■ Especially if you did not call them.
● October 15, 2024: Open Enrollment Begins
● December 7, 2024: Open Enrollment Ends
● January 1, 2025: New Coverage Begins
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University of Rhode Island College Of Pharmacy