HMO Guide for Seniors - Office of the Patient Advocate - State of ...

14 Paying for Prescription Drugs
M
ost Medicare HMOs in California include Part D
prescription drug coverage. This coverage is included in the
monthly premium you pay to your HMO. Each HMO has
different out-of-pocket drug costs.
Ask your Medicare HMO about out-of-pocket drug costs:
If you are in the
drug coverage gap,
or doughnut hole,
and need help
paying for your
drugs, call HICAP.
Do you pay a yearly deductible? This is the amount you pay
for drugs each year before your plan starts to pay.
Do you pay a flat fee (called a co-pay) or a percent of the drug
cost (called co-insurance) whenever you fill a prescription?
Is there a gap in the drug coverage? Most Medicare HMOs
have a gap, called the “doughnut hole.” During the gap, some
HMOs cover no drug costs. However, many HMOs cover
some generic drugs during the gap.
Is there a limit to your yearly out-of-pocket drug costs? If you
reach this limit, your Medicare HMO will cover most of your
drug costs for the rest of the year.
Buying Medicare Part D
There are rules about when
you can buy or change
Part D drug coverage.
See page 10.
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