How Does the Medicare Plan D Apply to Mesothelioma Patients?

The Part D drug benefit is prescription drug coverage for people with Medicare. Medicare offers Part D to everyone with Medicare. (People enrolled in Medicare are called Medicare beneficiaries.) Part D coverage may help you lower your prescription drug costs and help protect you from higher costs in the future. It can give you greater access to the anti cancer drugs you need to treat your cancer . To get Medicare Part D

drug coverage, you must join a plan that is run by an insurance company or other private company that has been approved by Medicare.

If you join a Medicare drug plan, you usually pay a monthly premium. If you decide not to join a Medicare drug plan when you are first eligible (able to join), you may pay a penalty if you decide to join later. If your income and resources are limited, you might qualify for extra help paying Part D costs.

There are different plans that vary in cost and the type of drugs that are covered by each plan and it is hard to compare them. As a mesothelioma cancer patient, your may incur huge annual drug expenses , so it is important to look at each plan’s coverage, as well as your cost-sharing obligations during coverage gaps. Coverage gaps are dollar limits that, when reached, leave you responsible for some or all of the drug costs

The coverage gap or “donut hole” is the gap in which you must pay 100% of your prescription costs. Once your total drug costs (what you and the plan pay for your prescriptions) reach a pre-set dollar amount for the year, you will hit the “donut hole.” Then you will pay all of your drug costs until the total out-of-pocket costs reaches another pre-set amount. Reaching this amount triggers what is called catastrophic coverage. After that, Medicare Part D will cover 95% of your drug costs and you will pay a flat co-pay or 5% of the cost of the drug for the rest of that year. (Keep in mind that some cancer drugs cost a lot and 5% can be several hundred dollars a month.)