Since Medicare Advantage plans are a type of Medicare plan, the prescription drug coverage provided under the TRAIL MAPD plan includes Medicare Part D prescription drug coverage. Prescription drug formularies (i.e., list of drugs covered) vary by plan. The TRAIL MAPD prescription drug coverage, like a Medicare Part D plan, must follow Medicare rules for which types of drugs are allowed to be covered. For example, many hormone replacement drugs have been determined not safe for individuals over the age of 65. For this reason, Medicare will not cover some drugs in this class. If you are uncertain whether a particular drug will be covered, you should call the health plan in which you are interested in enrolling to inquire.
Part D Coverage Stages
Since the TRAIL MAPD prescription drug coverage is a Medicare Part D plan, the member’s cost for prescription drugs under the TRAIL MAPD Program must follow the Medicare Part D drug coverage ‘stages.’ There are four drug payment stages: Annual Deductible, Initial Coverage, Coverage Gap, and Catastrophic Coverage. Unlike a standard Part D plan in which the retiree is required to pay a percentage of the full retail cost of the drug, members enrolled in the TRAIL MAPD Program pay only the plan’s standard copayment through the Initial Coverage and Coverage Gap stages. Paying only the standard copayment through the Coverage Gap is a valuable benefit for TRAIL MAPD members. Once a member reaches the Catastrophic Coverage stage (i.e., when the true out-of pocket costs reaches $5,000 for prescription drugs during the plan year), the member will pay either a small copayment or 5% coinsurance that is capped to limit a member’s out-of-pocket costs.
Part D-IRMAA Premium
Since the TRAIL MAPD prescription coverage includes a Medicare Part D benefit, Medicare requires that members of TRAIL MAPD whose annual income is above a certain limit to pay an additional premium called IRMAA (Income-Related Monthly Adjustment Amount). Medicare will look back at your tax return from two years ago to determine your income. For 2018, Medicare will be looking at 2016 tax returns. For 2017, individual tax filers with an income over $85,000 on their 2015 tax return are required to pay the IRMMA. Married-couples filing jointly with an income over $170,000 on their 2015 tax return are required to pay the IRMMA. These amounts could change for 2018. The Social Security Administration will send members whose income is verified by the IRS to exceed the established limits a predetermination letter indicating whether or not IRMAA will apply to the Medicare beneficiary. If applicable, IRMAA applies to both Medicare Parts B and D; therefore, members who pay an additional premium for their Medicare Part B coverage are the same members who will be charged the Medicare Part D IRMAA amount. Specifically, the 2017 base premium for Part B is $134.00*. Members will receive a quarterly bill in the mail from Social Security for these additional premiums. In order to remain in the Medicare Advantage plan, you must pay these additional premiums. Go to medicare.gov for IRMAA premium amounts.
*The Part B premium is for 2017 and may change for 2018.