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Understanding Pharmacy Benefits

Learn more about the ins and outs of your prescription drug coverage.

Part D Prescription Drug Coverage

Medicare Part D coverage is optional. It provides benefits to help you pay for your prescription medicines.

Learn about what your plan pays and what you pay for your prescription medicines.

Understanding Medicare Part D

Understanding Medicare Part D

Transcript

When it comes to your health insurance coverage, you have a lot of choices. But did you know that Original Medicare does not cover prescriptions? That’s why a Horizon Medicare Advantage plan gives you the peace of mind that you have prescription coverage. This is also known as Medicare Part D.

It’s important that you understand how prescription drug coverage works, including how much you’ll pay for medicines, so you can get the most from your plan.

There are four stages that make up Part D coverage. These stages determine how much your plan pays and the amount you’ll be responsible to pay out of pocket for your prescription medicines.

Remember to review your Explanation of Benefits statement that’s sent to you each month. Your coverage stage is in section two of the statement.

The dollar amounts included in this video are only examples to help you understand how coverage stages work. Your actual amounts may be different depending on your Horizon Medicare Advantage plan.

The first stage is the Deductible Stage. A deductible is the total amount you must pay out of pocket for your medicines before your insurance begins to pay.

Your deductible must be met each year. Once you meet your deductible, you’ll move into the Initial Coverage Stage. This means you’ll only pay the copayment or coinsurance – depending on the medicine. Your Horizon Medicare Advantage plan will pay the rest of the eligible cost for any covered medicine.

Your total drug cost – what you and your plan have paid for your medicines – add up during the Coverage stage.

Once you meet a specific dollar amount for the year, you’ll move into the Coverage Gap Stage, also known as the donut hole. You generally pay more for medicines during this stage.

So, how do you get there? Let’s take a look at an example of medicine that costs $100. If your copayment is $10 and your plan pays the remaining $90, the total cost of $100 is the amount that goes toward the Coverage Gap Stage. So, if you take more than one medicine, you may reach this stage quickly.

The good news is that during this stage, you only pay a percentage of the cost of the drug.

However, both your monthly premium and the amount paid for medicines not covered by your Horizon Medicare Advantage plan do not count towards the coverage gap total.

Once in the donut hole, you get a 70 percent manufacturer’s discount on covered brand name medicines and your plan pays an additional 5 percent. This means you’ll only have to pay 25 percent of the agreed cost of a brand name medicine. And, you can save more by getting generic medicines.

Once you have paid the maximum out-of-pocket costs set by Medicare, you will move to the Catastrophic Coverage Stage. You’ll then pay less for covered medicines for the rest of the year.

Making sense of Part D can be complicated. We want to make it easy.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Learn how to save money on your medicines.

Save Money on Your Prescription Medications

Save Money on Your Prescription Medications

Transcript

Prescription medications can cost a lot, especially if you take them on a regular basis.

If you qualify for Medicare, then you also qualify for prescription drug coverage, commonly known as Medicare Part D. Part D helps cover some of the cost of your prescription medications.

Even if you’re not taking prescription medications now, it’s a good idea to have coverage in place, in case your needs change in the future.

You can add a Medicare Prescription Drug Plan - Part D - to your Original Medicare coverage or you can enroll in a Medicare Advantage plan - Part C - that includes prescription drug coverage.

These plans are offered by private insurance companies like Horizon Blue Cross Blue Shield of New Jersey.

Horizon’s prescription drug coverage helps you pay less for your prescription medications.

Our prescription drug coverage includes zero dollar deductibles with certain Medicare Advantage plans and PDP enhanced plans; copays as little as one dollar for preferred generic prescription drugs when you use one of our preferred pharmacies; the convenience of 90-day, mail-order prescriptions delivered right to your home; an extensive list of covered prescription medications, both generic and brand-name; and a network of more than 1,500 pharmacies, including many popular retail pharmacies like CVS and Walmart.

Remember, you can save money by having your doctor prescribe generic drugs. The Federal Drug Administration ensures that generic medications are as safe and effective as their brand-name counterparts. That means you can significantly save on your prescription medications, without sacrificing quality or safety.

With Horizon’s Medicare prescription drug coverage, we make it more affordable for you to get the prescription medications you need.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Helpful Tips to Keep You on Track with Your Medicines

Home Delivery Pharmacy Service

Understanding your pharmacy benefits through Horizon Blue Cross Blue Shield of New Jersey can help save you time and money. Horizon Medicare Advantage members use AllianceRx Walgreens Prime for convenient home delivery pharmacy service.

Home delivery pharmacy service is safe, convenient and could save you money:

  • No more waiting in line at the pharmacy
  • A record of your medications is always available
  • With 90-day supplies, you could have fewer copayments
  • Free standard shipping, refill reminders and an auto-refill program
  • Delivery anywhere in the United States, even when you’re away from home
  • Medicines shipped in tamper-evident containers and delivered in plain packaging for privacy

A licensed pharmacist always processes your order and you can speak with the pharmacy team any time.

To start using the home delivery pharmacy service, visit alliancerxwp.com/home-delivery and follow the instructions to create an account. Once you’ve created an account, you can ask your doctor to send your prescription electronically to AllianceRx Walgreens Prime, or fax a prescription request to 1-800-332-9581.