The cost of Part D plans can vary. People with low incomes can get help with these costs from Vermont and Social Security’s Low Income Subsidy (LIS) or “Extra Help” program. Call the Social Security Administration at 1-800-772-1213 to apply for LIS.
Part D drug plans have four different costs: the premium, the deductible, co-payments, and the coverage gap or "donut hole." The Affordable Care Act increases coverage in the donut hole until the gap closes in 2020.
The premium is the amount you pay each month to the Part D plan for coverage. Each Part D plan has a different monthly premium. If you are on Medicaid and select a LIS-approved Part D plan, you should not have to pay any premium.
If you are on VPharm and select a LIS-approved Part D plan, you should not have to pay a Part D premium, but you still have to pay your monthly $15, $20, or $50 premium to the State of Vermont.
The yearly deductible is the amount you must pay out of your own pocket before your coverage begins. This amount is in addition to your Monthly Premium. The average deductible for 2015 is $320. Different plans may have higher or lower deductibles.
If you are on Medicaid, VPharm1 or LIS, you should not have to pay a deductible. If you have VPharm2 or VPharm3, you may have to pay the deductible (and co-payment) for non-maintenance drugs.
A co-payment is money you must pay out of your pocket when you fill your prescription at the pharmacy. Some plans do not require you to make a co-payment. Other plans may require you to pay $25 or more for every prescription.
If you are on Medicaid, your co-payment should not be more than $6.60 for any one covered drug. If you are on VPharm, your co-payments will be $1 or $2 for covered drugs. If you are on Medicare and a Medicaid home and community based waiver program or in an institution, your prescription co-payments should be $0.