In our previous post I shared information on Medicare Supplement (Medigap Plans). 

Now we will dive more into Medicare Prescription Drug Coverage.  Aren’t you excited???  

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Let’s get started!

Medicare Drug Coverage (Part D)

How to get prescription drug coverage

Medicare drug coverage helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should still consider getting Medicare drug coverage.

Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.

Generally, you’ll pay this penalty for as long as you have Medicare drug coverage.

You can get coverage 2 ways:

(1) Medicare Prescription Drug Plans (sometimes called “PDPs”) add prescription drug coverage to Original Medicare, some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans, and Medicare Medical Savings Account (MSA) Plans.

(2) Some Medicare Advantage Plans (like HMOs or PPOs) or other Medicare health plans offer prescription drug coverage. You generally get all of your Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and Part D through these plans.

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Consider all your drug coverage choices before you make a decision, this is very important.  There are tools I have in place to help simplify this process so you can estimate your medication costs.

 Look at the drug coverage you may already have, like coverage from an employer or union, TRICARE, or the Department of Veterans Affairs (VA). Compare your current coverage to Medicare drug coverage.

The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options. 

If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.

What factors should I consider when comparing Medicare drug plan choices?

Coverage — Medicare drug plans will cover generic and brand-name drugs. Most plans will have a formulary, which is a list of drugs covered by the plan.

Cost — Monthly premiums and your share of prescription costs will vary depending on which plan you choose.

Convenience — Drug plans must contract with pharmacies in your area. Check with the plan to make sure the pharmacies in the plan are convenient for you.

 What drugs are covered by Medicare drug plans?

Each plan may cover different drugs, so there’s no single formulary (drug list) that fits all plans. All Medicare drug plans must make sure the people in their plan can get medically necessary drugs to treat their conditions.

Drug lists, prior authorization, step therapy, and quantity limits are some of the coverage rules plans use to make sure certain drugs are used correctly and only when medically necessary.

Remember there are tools available that I am able to use to help simply this process so that you are able to see your estimated drug costs.  These illustrations can provide you with the information you need to deter your medication costs and compare plans and make an informed decision.

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You can view my Power 5 Video on the subject below:

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This concludes our content on Medicare Prescription Drug Coverage. Riveting stuff right?

One thing to remember is that every person situation is unique.  It is important that we take all the time needed to fully access your individual situation in order to select the option best for you.

In our next post we will be discussing Medicare Advantage Plans.

If you got questions in the meantime drop me a line or give me a call.