Medicaid Enrollment

What is Medicare Part D?

What is Medicare Part D? Medicare Part D is a federal program of Medicare that is directed through private insurance companies. These private insurance companies offer retail prescription drug coverage to Medicare recipients. Part D helps thousands of Medicare beneficiaries pay for much-needed prescription drugs; prior to 2006, these patients would have to pay thousands of dollars out-of-pocket for the same drugs. It’s a good thing that the times have changed.

Essentially, Medicare Part D is insurance for your medication needs. A patient will pay a monthly fee or premium to a private insurance carrier for the Medicare Part D plan. In return for this monthly premium, the recipient will gain access to the insurance’s network of pharmacies to purchase prescription medications. This is great news for the Medicare Part D recipient, as they will pay a copay or percentage of the drug’s cost instead of the full amount. The private insurance company will then pay the difference.

Medicare Part D Donut Hole

A Medicare Part D insurance card will be separate from the Medigap plan. The Medicare coverage gap – also known as the donut hole – works like this: after your Medicare Part D coverage has paid a certain set amount for your prescriptions, you may have to pay for the rest of the costs yourself. This is based on a yearly limit. The temporary limit on what the Medicare Prescription Drug Plan will pay for your covered drugs is called the coverage gap or “donut hole.” Benistar offers prescription drug plans that cover this coverage gap, so you’ll never be without the medication you need to live a healthy life.

Benistar Prescription Benefits under Medicare Part D

Benistar prescription drug plans for group plans are Employer Group Waiver Plans (EGWP) that are established for groups under Medicare Part D.  Our partners contract with the Centers for Medicaid and Medicare Services (CMS) to serve as a Medicare Part D Plan Sponsor. The plan manages compliance with CMS regulations regarding Part D plans.

Many employers and organizations providing drug coverage for retirees are currently filing for the Retiree Drug Subsidy (RDS). Our low premium rates include the government subsidy. There is no additional subsidy filing required, saving you administrative costs associated with RDS compliance. In fact, the average subsidy received through an EGWP plan with a non-Part D wrap exceeds the RDS program subsidy. Benistar EGWP plans offer the following advantages for employers and their retirees:

  • Nationwide Plan Availability
  • Flexibility in plan design
  • Flat co-pays or coinsurance
  • Fill the Medicare coverage gap (“donut hole”)
  • Choose from our standard plans or customize a plan with underwriting approval
  • With the addition of a non-Part D wrap product, groups can take full advantage of the brand name drug discount provided by the Coverage Gap Discount Program
  • Fully Insured — cap your retiree health liability with an insured plan

Our customer service team is specifically focused on the administration of retiree medical and prescription drug plans.  We’ll assist your retirees without rushing them off the phone and make them feel comfortable. Contact Benistar Admin Services today for more information.

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