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Medicare Part D

Medicare offers prescription drug coverage for everyone with Medicare. This is called "Part D."


Medicare prescription drug coverage can protect against future drug costs and give you access to drugs that you can use to stay physically and mentally healthy. This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.

To get Medicare drug coverage, you must join a Medicare drug plan. Medicare drug plans are run by insurance companies and other private companies approved by Medicare. Part D is optional.

There are two ways to get Medicare prescription drug coverage.

1) Join a Medicare Prescription Drug Plan. These plans are sometimes called "PDPs" or “stand-alone PDPs”. They add drug coverage to the Original Medicare Plan but are managed separately.

2) Join a Medicare Advantage Plan (like an HMO or PPO) or another Medicare health plan that includes prescription drug coverage. You get all of your Medicare coverage (Part A and Part B), including prescription drugs (Part D), through these plans. These plans are sometimes called "MA-PDs such as Leon Cares."

How Much Does Medicare Drug Coverage Cost?


Your costs will vary depending on the drugs you use, the plan you choose, and whether you qualify for extra help paying your Part D costs. Exact coverage and costs are different for each plan, but all Medicare drug plans must provide at least a standard level of coverage set by Medicare.

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

If you have any questions or need information, please call our Member Services. 7 days a week, from 8:00 am to 8:00 pm, Eastern Standard Time.

Calls to these numbers are free:

Main: 305.559.5366

Toll Free: 1.866.393.5366

TTY users should call 711.

You may also visit www.socialsecurity.gov on the web or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.


Public Notice

Coordinated Care Plans have the opportunity to terminate their contract with the Centers for Medicare & Medicaid Services (CMS) or reduce their service area annually. Leon Medical Centers Health Plans will give you notice at least 90 days before the effective date of a termination of our contract with CMS or reduction or our service area and include a description of alternatives available for obtaining Medicare services within the service area, including alternative MA plans, Medigap options, original fee-for-service Medicare.



Our Medicare Prescription Drug Benefit is only available to members of our MA-PD plan.


Prescription Drug Benefit Summary

LMC Health Plans Medicare Advantage Prescription Drug Plan
2017
Monthly Premiums
$0
Annual Deductible
$0
Initial Coverage: Your plan will pay part of the cots for your covered drugs and you will pay the other part. The amount you pay when you fill a covered prescription is called the co-payment. You pay the following until total yearly drug costs each $4,000.
You pay the following for your covered prescription drugs:

Drug Tier
Preferred retail cost-sharing (in-network) (up to a 30-day supply)
Standard retail cost-sharing (in-network) (up to a 30-day supply)
Preferred retail cost-sharing (in-network) (up to a 90-day supply)
Standard retail cost-sharing (in-network) (up to a 90-day supply)
Tier 1 (Generic Drugs)
$0 copay
$5 copay
$0 copay
$15 copay
Tier 2 (Brand name drugs)
$0 copay
$10 copay
$0 copay
$30 copay
Tier 3 (Specialty drugs)
33% Coinsurance
33% Coinsurance
A long-term supply is not available for drugs in tier 3
A long-term supply is not available for drugs in tier 3

Coverage Gap: After the total yearly drug costs (paid by you and your plan) reach $4,000.
Your plan will continue to provide generic prescription drug coverage until your total out-of-pocket costs reach $4,950. Once your total out-of-pocket costs reach $4,950 you will qualify for catastrophic coverage.
Catastrophic Coverage: After your yearly out-of-pocket drug costs reach $4,950.
You pay the greater of: $3.30 copay for Generics and $8.25 copay for Brand or 5% coinsurance. For Specialty drugs you pay 5% coinsurance.

If you have any questions or need information, please call our Member Services, 7 days a week from 8:00 am to 8:00 pm, Eastern Standard Time, at 305-559-5366, or toll-free at 1-866-393-5366. TTY users should call 711.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or Your Medicaid Office.

Network pharmacies must be used to access your prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.


LIS Premium

Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs.

Leon Medical Centers Health Plans premium includes coverage for both medical services and prescription drug coverage

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help form Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

This table shows you what your monthly plan premium will be if you get extra help.

Your Level of Extra Help
Monthly Premium for LMC Health Plans
100%
0
75%
0
50%
0
25%
0

You must continue to pay your Medicare Part B premium. This does not include any Medicare Part B premium you may have to pay. Please note that LMC Health Plans does not charge a plan premium.

If you aren’t getting extra help, you can see if you qualify by calling:

• 1-800-Medicare of TTY/TDD users call 1-877-486-2048 (24 hours a day/7 days a week),
• Your State Medicaid Office, or
• The Social Security Administration at 1-800-772-1213. TTY/TDD users should call
1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

If you have any questions or need information, please call our Member Services, 7 days a week, from 8:00 am to 8:00 pm, Eastern Standard Time, at 305-559-5366, or toll-free at 1-866-393-5366. TTY users should call 711.


Out of Network Coverage

Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Leon Medical Centers Health Plans - Leon Cares (HMO).