Medicare Part D Prescription Drug Coverage

Have you ever wondered what is involved in Medicare Part D prescription drug coverage?

Contrary to popular belief, when you are a beneficiary of Medicare getting Part D coverage for prescription drugs from Medicare is not automatic. Rather, it is an option that you can take. People that take medications may find this valuable. When you first find out that you are eligible and don’t immediately sign up for the Part D coverage of Medicare, you might need to pay a penalty for late enrollment if you decide to go through late enrollment.

The moment they reach the age of sixty-five, people are enrolled automatically in Part A, Part B, and the Original Medicare benefits. However, what you might not realize is that the cost of your medications is not covered by the Original Medicare except the ones you get as an inpatient in the hospital or even as an outpatient, in some cases. There are specific prescription drugs that are covered by Medicare Part B, and this is something you can avail of in a doctor’s office or other outpatient settings. These, however, tend to be the types of medication that you need a doctor to administer, such as a drug infusion.

You will need to sign up for coverage under Medicare Part D if you want help with the other costs of medication.

What are the available Medicare Part D Drug Plans?

Knowing as much as you can about the different drug plans that fall under Medicare Part D will get you far regarding knowing exactly what your options are. There are two different methods you can avail of Medicare Part D coverage for prescription drugs, depending on whether you are enrolled in Medicare Advantage or the Original Medicare. Also known as Medicare Part C, Medicare Advantage is another method of availing of the benefits of the Original Medicare through the health plan of Medicare. Also, the benefits beyond the federal program are also covered by many plans, including benefits you can avail of for prescription drugs.

Coverage Availability of Medicare Part D:

You can avail of the prescription drug plan under Medicare Advantage. This means you get a Part C plan including coverage for prescription drugs so that all the benefit of Medicare fall under one plan.

Also, in the area where you live, you can enroll in any prescription drug plan under Part D and add this benefit to your Medicare original coverage through a stand alone prescription drug plan under Medicare Part D.

Who is eligible for the prescription drug coverage under Medicare Part D?

Those who have parts A or B and live in the service areas of a prescription drug plan under Medicare Part D. If you plan on getting coverage for prescription drugs through the plans under Medicare Advantage, you need to have both Parts A and B and live in a Medical Advantage Plan service area. You also cannot have ESRD which stands for end-stage renal disease. Double check with the plan you want as not every plan for Medicare Advantage covers prescription drugs.

When to sign up for coverage under Medicare Part D?

You don’t have to enroll in coverage under Medicare Part D. This decision affects the original coverage you have. However, you may benefit from a stand-alone prescription drug plan under Medicare Part D if you are taking medications currently. This will help with the cost of your prescription drugs. On the other hand, you can decide to enroll in a Prescription Drug Plan under Medicare Advantage, or Part C under Medicare. This includes the benefits of Part D. If you don’t want to do this, you might have to pay out of pocket for your medications unless you have other types of insurances.

The moment you are eligible, it is also a good idea to sign up for Part D under Medicare. If you decide to enroll later or go sixty-three days or more consecutively without coverage for prescription drugs under Medicare Part D, you might get a penalty for late enrollment unless you can show that you have prescription drug coverage which is creditable in the time you were not enrolled in Part D. Prescription drug coverage that is creditable is the kind that pays for at least as much as the standard Part D coverage for Medicare prescription drugs. For instance, the health insurance you get through your employers might be considered credible. Every year, your insurance needs to inform you whether you have creditable insurance or not. If unsure, check with your insurance company as soon as you can.

To be eligible to enroll in a plan for Medicare Prescription Drugs, you need first to have either or both Part A and B to enroll in a plan for Medicare Advantage. For Part D, you are first eligible to sign up for coverage under Plan D during your IEP or Initial Enrollment Period. Typically, this takes place in the same period of seven months as your Original Medicare Initial Enrollment Period. This is the seven months that begin three months before you turn the age of sixty-five. It includes the month of your birthday and ends three months later. Usually, a very good time for signing up for the prescription drug coverage under Medicare is as soon as you enroll in Original Medicare.

During the Annual Election Period or AEP, it is also good to sign up for Medicare Part D coverage. This is also known as the Open Enrollment Period or the Fall Open Enrollment for Medicare and Medicare Advantage prescription drug coverage. This takes place between October 15th to December 7th. In this period you can:

• Enroll or switch plans under Medicare Advantage Prescription Drugs.
• Disenroll from your plan under Medicare Advantage and return to Original Medicare.
• Enroll in Medicare Part D Prescription Drug Plan or change from one prescription plan to a different one.
• If you are already enrolled, you can disenroll from your Medicare Part D prescription drug coverage.

After the Annual Election Period has passed, you have a few chances to change to Part D coverage. If you enroll in a plan under Medicare Advantage, you can use the Disenrollment Period from January one to February fourteen to disenroll from the plan Medicare Advantage and return to the Original Medicare. When you do this, whether or not your plan under Medicare Advantage includes coverage for prescription drugs, you can use this same period to enroll in a Medicare Prescription Drug Plan that is stand-alone. During this frame of time, these are the only changes you are allowed to make.

As a general rule, you can enroll in a prescription drug plan under Medicare or make changes to your coverage under part D in the periods mentioned above. On the other hand, a few circumstances are qualifying you for a SEP or a Special Election Period when you can enroll in a Prescription Drug under Medicare Part D or a prescription drug plan under Medicare Advantage outside of the Annual Election Period. Some of these circumstances might qualify you for a Special Election Period including qualifying for Medicaid or moving outside of the service area of your plan. Any time of the year that you have a situation that qualifies you, a SEP can take place. If you are unsure whether or not your circumstances apply, call us to inquire. Our licensed agents are more than happy to help you understand your options.

In this phase of your benefits under Part D, you pay a portion higher for your prescription drug costs. After you spend a specific amount, you will reach the phase for catastrophic coverage and only need to pay small coinsurance or copayment for your medications covered for the rest of the year. Learn more about the costs specifically if you enter into a donut hole, also known as a coverage gap.

There are a few things you can do to lessen your costs for prescription drugs. Which actions can you take? Knowing what these may help lessen prescription drug costs. Actions you can take include:

Apply for the Low-Income Subsidy or Extra Help program if your income is limited. Your low-income beneficiaries are assisted by Extra Help for their costs of prescription drugs. You might be eligible for not entering the gap of coverage. Get in touch with the Medicaid program in your state to find out whether or not you qualify for this.
Look for assistance programs. The National Organization for Rare Disorders and the National Advocate Foundation might have programs helping with the drug costs of your prescription. Comprehensive information about private, state or federal assistance programs in your community is available from the National Council on Aging.
Use your plan membership card for your Medicare Plan when you get medications. You could avail of possible discount rates when you sue your card. Money spent on medications covered automatically counts towards the deductible of your plan if it has one.
If you are required to use network pharmacies for your Medicare plan, be certain that you fill your prescription at the pharmacy at the network of your plan or you may not be covered. Plus, some plans might have lower sharing costs if you use not just the pharmacies in the network but the pharmacies preferred in the network of your plan. Check your plan to make sure whether you could save money by getting your prescriptions filled in certain pharmacy groups.
Ask your prescription plan about programs for mail order. This might save you on the cost of medication that takes longer periods, such as for a supply of thirty or ninety days.
Switch to medications that cost less. Talk to your health care provider about using over the counter or generic prescription drugs and if these options could work for you. Many generic drugs work just as well as branded ones, and you may be able to save money annually and keep away from the gap of coverage.
How much is Part D under Medicare? Depending on a few factors, your actual costs for prescription drug coverage under Part D of Medicare can vary. These depend on:

How often you take your prescription drugs and what they are.
The drug plan you choose, whether it is under Medicare Advantage or stand-alone Part D under Medicare.
Whether your pharmacy falls under the network of your plan
Whether you get Extra Help for paying for the costs of Part D under Medicare.
Whether your prescribed drugs are on the formulary list of the Part D Medicare plan. Keep in mind that formularies change and you will be notified regarding this.
Your monthly premium is one cost to consider. Most stand-alone drug plans and Medicare Advantage plans to charge a premium each month that varies depending on the plan. It is your responsibility to pay for the plan you select. Note that if you are enrolled in a prescription drug plan and are also enrolled in Part B under Medicare, you need to continue paying the premium for Part B. Plus, if you enroll in a plan of Medicare Advantage without or with coverage for prescription drugs, you need to continue paying the premium for Part B along with premiums for the coverage under Medicare Advantage.

Aside from the premiums each month, your coverage for Part D under Medicare might also include:

Coinsurance/Copayment- this amount is what you pay out of your pocket every time you purchase prescriptions. It is your share of the costs after everything has been paid for by Medicare and you have reached the deductible of your plan. Typically, copayments are flat amounts paid for by you. For instance, when filling out prescriptions, you might pay a flat amount of $8 copayment while the percentage you owe is the coinsurance. For generic medications, you might pay coinsurance of $10. From plan to plan and depending on drug tiers you belong to at the time of filling out prescriptions, these costs vary. Medications covered by Medicare are put into different costing tiers and compared to lower tiers, prescription drugs fall into higher tiers.
Annual deductibles- this amount is what you pay for your prescription before your Medicare Advantage Prescription Drug or Medicare Plan begins to share in the cost. Deductibles differ according to the respective plans. It might be a possibility to find one with a deductible amount of $0
Can low-income earners get help with Medicare plans? Knowing all there is to know about Extra Help Will enable you to know what your options are regarding receiving extra aid that will benefit you financially.

Also known as Extra Help, the Low-Income Subsidy is a program offered by Medicare. People with limited income are eligible for these. If you enroll in Medicare and meet the income requirements of the program, you qualify automatically for Extra Help. You then get help for paying for your share of the costs for Medicare Part D including cost sharing, deductibles, and premiums.

People in the following situations are eligible for Extra Help automatically. Check to see if you fall in any or all of these categories to know for sure where you are automatically eligible for Extra Help.

You get SSI benefits or Supplemental Security Income
You are enrolled in a Medicare Savings Program
You are entitled to Medicare and get state Medicaid program full coverage.
Those who qualify for extra help automatically but don’t enroll in a drug plan under Medicare Prescription; you will be enrolled in a plan by Medicare so that you will get help with prescription drugs payments. Medicare sends you a letter showing what you are covered for. There is a Special Election Period for those who want to change their Drug Plan under Medicare Prescription. Call 1-800-633-4228 or 1-800-Medicare to talk to a customer service representative 24/7.

One of the times you can enroll in the Medicare Advantage Prescription Drug Plan or the Medicare Prescription Drug Plan is called the Annual Election Period, as mentioned above. Depending on your circumstances, you can also change your plan outside of the time allotted for this period using the Special Election Period. Find out whether or not you are eligible for this and know which options you have that will cover your medications.

Use the links below for email or scheduling an appointment on the phone to tailor your own particularly Medicare Information according to your needs. Knowing what options you have and how these can cover what you need regarding prescriptions enables you to know what to expect each month. There is a button on this page to Compare Plans, as well. Knowing as much as you can about all your options will give you the opportunity to make all the right decisions when it comes to the Medicare Part D prescription drug coverage.