Medicare Prescription Drug Coverage
Whether or not you take prescription drugs on a regular basis, having an insurance plan the covers the cost of pharmaceuticals is a good idea. It can lower the cost of your current prescriptions and even prevent you from incurring unexpected costs if you end up being prescribed them in the future. In fact, if you don’t enroll for prescription coverage when you are first eligible (regardless of whether you currently use prescribed medications), you may be charged a fee on top of your premium for as long as you have Medicare drug coverage. Medicare Parts A and B (traditional Medicare) does not cover medications, and that is where Medicare Part D takes over.
There are two ways to receive prescription drug coverage through Medicare: through Medicare Part D or through a Medicare Advantage Plan. It is important to note that you cannot be enrolled in Medicare Part D while you have a Medicare Advantage Plan. Since you must choose one or the other for prescription coverage, it is critical that you review each plan’s benefits to make a sound decision about which plan meets your needs.
You may also consider a Medicare supplement plan to go with your prescription drug plan, to cover other gaps in your Medicare policy.
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Medicare Coverage in the Roaring Fork
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Medicare Part D
There are a myriad of plans offered within Medicare Part D. The price for premiums, deductibles, and covered medications varies by plan, so careful review is important.
The list of drugs a plan covers is called a formulary. If your prescription is not covered in the plan’s formulary, chances are they have another similar medication that they will cover. All Medicare drug plans are required to have at least 2 drugs per drug category, but it is up to their discretion which two brands they will cover. These formularies may also change from year to year, but the insurance company is required to give you 30 days’ notice if they plan on discontinuing coverage for your current prescription.
Generally, a plan’s formulary is arranged into “tiers” that determines how much you are charged for your prescription. The first tier is generally made up of generic drugs and has the lowest copay. The second tier contains the company’s preferred brand-name drugs and has a higher copay. The third tier generally contains the company’s non-preferred brand-name drugs, in which the copay is even higher. Each company or plan may have more or less tiers or they may be structured differently.
How To Enroll in Medicare Part D
Call our office at 970-300-9252 to enroll in Medicare prescription drug plans.
If you choose to use Medicare Part D for your prescription needs as opposed to a Medicare Advantage Plan, be sure to enroll as soon as you are eligible to ensure you are not penalized if you need to add Part D in the future. You are eligible to enroll three months before you turn 65 and your enrollment period ends three months after. Outside of this period you may add, change, or drop your Part D benefits from October 15–December 7 each year.
If you have “creditable drug coverage” through a Medicare Advantage Plan or other insurance plan when you turn 65, you will not be penalized if you switch to Medicare Part D. However you must be enrolled in some type of “creditable drug coverage” continually after turning 65. Otherwise, if you need prescription drug coverage in the future, you will be charged a penalty based on how long you were without this coverage. The penalty is not a one-time fee, but instead an overall increase in premiums for the remainder of your Medicare coverage.