Above: Medicare Part D is Medicare Prescription Drug Coverage. Photos by Pixabay.
Medicare coverage can be complicated. Still, it’s well worth taking the time to learn about the different types of coverage available.
As we’ve learned earlier in this series, Medicare Parts A & B are programs operated and administered by the government that cover hospital care and other health-related services. Medicare Part C, also known as the Medicare Advantage Plan, is administered by private companies and offers additional coverage which may include dental, vision and some prescription medications.
Part D is Medicare Prescription Drug Coverage, an optional federal government program that can help Medicare beneficiaries pay for self-administered prescription drugs. Anyone on Medicare (with either Part A or Part B) is entitled to drug coverage, regardless of income, according to Medicare.gov. No physical exam is required for Part D.
The drug coverage is either a stand-alone prescription drug plan (PDP) as a supplement to traditional Medicare, or a Medicare Advantage prescription drug plan (MA-PD), which provides all Medicare-covered benefits, including drugs.
Medicare.gov states, “You cannot be denied a prescription drug plan for health reasons or because you already use a lot of prescription medications.”For most people, joining Part D remains voluntary, not mandatory. But you can — and should — expect some out-of-pocket costs for certain medications.
What You Should Know About Part D
To get Part D drug coverage, you must join a plan run by an insurance company or other Medicare-approved private company. Each plan can vary in cost and in their “formulary,” which is simply the list of brand name and generic medications that are covered.
Be aware that if you should decide not to get Medicare drug coverage when you’re first eligible, you’re likely to pay a substantial late enrollment fee, unless you have other creditable prescription drug coverage or you qualify for extra help.
It can be confusing to choose one plan out of so many offerings for Medicare Part D.
“There can be several benefits of using an independent agent to help you evaluate your overall Medicare coverage,” said Ron Altman of Affordable Medicare Solutions. “Medicare Part D plans constantly change.”
He says that what was best for a senior two years ago, may not be the best option today. “Independent agents are encouraged to learn the details and benefits of multiple insurance carriers. Many times, they can find plans that seem customized for specific needs and preferences,” Altman said.
Some seniors will outlive their retirement savings or simply do not have enough money saved for late-in-life illness, Altman says. An additional service some brokers provide is helping them find funding resources, as well as offering an annual insurance review.
One Man’s Experience
Convenience may be an important factor for some older adults. “My Part D coverage is as simple as asking my physician to send new prescriptions to the pharmacy benefits manager I use as my Medicare insurance carrier,” said a colleague who requested anonymity.
Most physicians are comfortable sending the majority of prescriptions via the internet, he said. “Many pharmacies are equipped to receive prescriptions in this manner. When I selected my pharmacy, I opted for convenience and lowest cost.”
In his case, his insurer offered a mail-order service for prescriptions, he explained. “What could be easier?”
When he needs a refill, he simply selects the online prescriptions that are ready to be refilled. “If a prescription has expired, the online pharmacist will contact my physician, obtain a new order or advise me to see my doctor for a routine check-up, if that’s needed first,” he said.
“A few days after placing my order, my medicines arrive in the mail, with no shipping cost — and I’m set for another 90 days.” The billing goes to his credit card, which makes the process convenient.
According to AARP, although the selection process may be time consuming, a large cost variation in Medicare Part D coverage options may save you anywhere from $100 to $500 for a 30-day supply of medications. It’s worth your time to do your Part D homework, and to make time for an annual review of your Part D plan.
Things to Consider
Before you decide whether to sign up for Medicare prescription drug coverage, take the time to understand how the program works as a whole. One well-known pharmacy benefits management company (Express Scripts) suggests four important items to think about before choosing any plan:
- Know that lower premiums aren’t always better choices.
- Make sure your medicines are covered in the formulary before choosing a plan.
- Find a plan that works with a pharmacy conveniently located to you.
- Look for a plan that has 24/7 pharmacy support.
More Parts to Medicare
Medicare Part C was covered in the September Atlanta Senior Life Health column; Parts A & B were covered in the August edition. This month, we finish the topic with Medicare Part D.
Some Important Notes
Philip Moeller, author of the book “Get What’s Yours for Medicare,” goes into great detail about Part D in his article “It can pay to pick a new Medicare Part D drug plan.” He explains that Part D plans can vary in many ways and may have a significant effect on an enrollee’s out-of-pocket spending, including premiums, deductibles, cost sharing, ‘tier’ placement and the list of covered drugs on the formulary, as well as preferred pharmacies, Moeller says.
The ‘tier’ that your medications are in will determine your portion (co-pay) of the drug cost. A typical drug benefit includes several tiers, such as:
- Tier 1 usually includes generic medications;
- Tier 2 usually includes preferred brand-name medications;
- and Tier 3 usually includes non-preferred brand name medications.
Also, a Medicare drug plan can make some changes to its formulary during the year (within guidelines set by Medicare). If the change involves medications you’re currently taking, the plan must do one of these:
- Provide written notice to you at least 60 days prior to the date the change becomes effective, or
- At the time you request a refill, provide both of these: 1] A written notice of the change, and 2] a 60-day supply of the drug under the same plan rules as before the change.
Need More Help?
Here are some useful sources:
- Use the online plan finder program on Medicare’s website, Medicare.gov.
- Call Medicare’s helpline at 800-633-4227 (available 24/7). Have your list of prescriptions at hand, with dosages and how often you take them.
- Make an appointment with a reputable independent insurance agent.
- Contact your state health insurance assistance program (SHIP) to speak with a counselor who can help you find an option that fits your circumstances. In Georgia, visit mygeorgiacares.org or call 1-866-552-4464, option 4.
This is general information to help older adults begin learning about Medicare. For specific and personal information, contact Medicare at 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048.