Prescription Benefits
- Do I need to sign up for a separate Medicare Prescription Drug Plan to receive prescription coverage?
- Can I go to any pharmacy to fill my prescriptions?
- Does Elderplan prescription coverage have a “coverage gap”?
Do I need to sign up for a separate Medicare Prescription Drug Plan to receive prescription coverage?
No. As an Elderplan member, you already have this coverage, so there’s no need to sign up for a separate Medicare Prescription Drug Plan. That’s because Elderplan is a Medicare Advantage Part D (MA-PD) plan, which includes the Medicare Prescription Drug Plan. That means we contract with Medicare to provide both comprehensive health care coverage and affordable prescription coverage in one easy plan. So you get all the great benefits of Original Medicare plus a lot more! In fact, you enjoy some of the most generous prescription drug benefits in Greater Metropolitan New York. So don’t listen to others who say you need a separate prescription drug plan. You’re covered!
Please Note: If you sign up for a separate prescription drug plan, you will automatically be disenrolled from Elderplan and will lose not only your generous prescription drug coverage, but all of your great Elderplan benefits.
Get more answers to your questions about Elderplan’s Medicare Prescription Drug Coverage.
Can I go to any pharmacy to fill my prescriptions?
No. Generally, benefits are only available at contracted network pharmacies. Normally, we only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. Whenever possible, before you fill your prescriptions at an out-of-network pharmacy, call Customer Service to see if there is a network pharmacy in your area where you can fill your prescription. To find pharmacies in our network, use the online provider locator.
Does Elderplan prescription coverage have a “coverage gap”?
With Elderplan Classic: Zero Premium (HMO), and Elderplan Independence Choice (HMO POS), you get unlimited Tier 1 generic drugs through the coverage gap. For all other formulary drugs you will pay 50% of the price for brand name drugs and 86% of the price for generic drugs; generics not listed on Tier 1. After you reach the catastrophic coverage level, you will pay the greater of $2.60 for generics (including brand name drugs treated as generics) and $6.50 for all other drugs, or 5% co-insurance. Once your prescription drug spending by you and the plan reaches $6,447.50 plan co-payment and co-insurance amounts apply.
Elderplan for Medicaid Beneficiaries (HMO SNP), Elderplan Plus Long-Term Care (HMO SNP), and Elderplan Medicaid Advatage (HMO SNP) members won’t have to worry about the coverage gap. And, because Medicaid pays for your prescriptions throughout the coverage gap, you only pay nominal prescription drug co-payments no matter how many medications you take.
With Elderplan Advantage for Nursing Home Residents (HMO SNP) and Elderplan Extra Help (HMO) there is a coverage gap. After your total yearly drug costs reach $2,930, you pay 50% of the price for brand name drugs and 86% of the price for generic drugs until your yearly out-of-pocket drug costs reach $4,700 for generic drugs only. After your yearly out-of-pocket drug costs reach $4,700, you pay a catastrophic level co-payment or co-insurance.
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, TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday, TTY/TDD users should call 1-800-325-0778; or your State Medicaid Office.
