August 16, 2021
Agency
Medicare Part D Drug Plans
Prescription drugs are among the most common, recurring medical expense for most Americans. If you are over 65 years old, you can choose to enroll in Medicare and join a Medicare drug plan to help offset your prescription expenses.
Understanding the Parts of Medicare
Medicare is a government-sponsored health insurance program for certain individuals that also offers additional private prescription drug options for enrollees. There are four types of Medicare:
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Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care. Generally, there is no monthly premium if you qualify and paid Medicare taxes while working.
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Medicare Part B helps cover medical services like doctors’ services, outpatient care and other medically necessary services that Part A doesn’t cover. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible.
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Medicare Advantage Plans, also known as Medicare Part C, are combination plans managed by private insurance companies approved by Medicare. They are typically a combination of Part A, Part B and sometimes Part D coverage, but must cover medically necessary services. These plans have discretion to assign their own copays, deductibles and coinsurance.
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Medicare Part D is prescription drug coverage and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium.
Many people also purchase a supplemental insurance policy, such as a Medigap plan, to handle any Part A and B coverage gaps.
These plans all take different approaches to prescription drug coverage, so it is essential to know your options to choose the appropriate plan.
Which Drug Plan Is Best for You?
Medicare drug coverage, often called Medicare Part D, is an optional yet invaluable benefit that can significantly reduce prescription costs for an affordable monthly premium. Certain Medicare plans don’t automatically offer prescription drug coverage. To get this specific coverage, you need a Part D prescription drug plan.
Part D prescription drug plans are private insurance plans offered through major insurers. These plans provide a variety of benefits depending on the plan selected. You may also choose to obtain your drug coverage through a Medicare Advantage (Part C) plan. Most Part C plans, though not all, offer prescription drug benefits as part of their additional coverage options.
Once you have selected a prescription drug plan, when you visit your pharmacist, present your plan enrollment card to get your prescription filled. Specific drug coverage is based on your selected plan’s terms. All prescription drug plans (in Part C and Part D coverage) include a formulary (list) of the drugs covered, including both generic and brand-name drugs.
To receive the full coverage for the drug chosen, you need to take one of the drugs listed on your plan’s formulary. If you don’t choose one of the included drugs, you may not have coverage until your doctor submits the necessary pre-authorization paperwork to your plan’s provider.
How Much Do Prescriptions Cost?
Medicare prescription drug formularies typically have four tiers, with the costs varying by tier.
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Tier 1 drugs generally are generic medications and are the least expensive.
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Tier 2 drugs are often called preferred brand-name drugs. These are specifically chosen for your plan because they provide the most coverage, but are a bit more expensive.
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Tier 3 drugs are nonpreferred brand–name drugs, and because they fall outside Tier 2, they generally are pricier.
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Tier 4 drugs are the most expensive, and are usually specialty drugs that are used when another type of drug isn’t adequate.
If your provider feels you can only benefit from a higher-tier prescription, then there are ways to file an appeal through your plan in order for that drug to receive coverage at a lower tier.
Because Medicare prescription plans include different formulary and tier setups, you want to ask your agent about which plan gives you the greatest benefit based on the drugs you take or may take in the future.
Get the Right Prescription Drug Plan
A good time to enroll in either a Part D prescription drug plan or an Advantage plan is when you first become eligible for these benefits. If you don’t join a Medicare drug plan right when you are first eligible, you may have to pay a late enrollment penalty.
Your Medicare insurance agent at Seniors Health Plan Advisors, 516-319-2214 can help you choose the best prescription drug plan.
Tags: Medicare