Medicare Part D

Medicare Part D are prescription drug plans. These plans set copayments for your covered drugs based on whether they are generic, brand-name, preferred, or specialty. You can add this plan to supplement your Original Medicare.

Offered separately from Original Medicare, Part D covers your prescription medications, which fills a critical gap in coverage. Many seniors take prescription medications regularly to maintain their health and quality of life. By signing up for prescription drug coverage, you can ensure that you will be providing yourself with a safety net of coverage that will also help you save money on your prescriptions.

Medicare Advantage plans with prescription drug coverage follow the same standards as Part D plans, so you can expect the same coverage. Each plan will vary in the drugs they cover.

Coverage

Medicare Part D plans cover at least two drugs in each of the most commonly prescribed categories/classes of drugs. Effectively all anticancer, anticonvulsant, antidepressant, antipsychotic, antiretroviral, and immunosuppressant drugs are covered.

Each plan lists its covered drugs in a formulary, which you can search before signing up with the plan. If you are prescribed a medication that is not covered on your plan’s formulary and cannot be substituted with a drug that is covered, you and your prescriber can request an exception. You can also do this if you need your drug in a quantity higher than the recommended limit.

Your plan will cover generic and brand-name drugs. Your plan can make changes to the drugs they cover, but they will notify you before they do so. If any changes affect a prescription you are currently taking, you will receive notice at least 30 days in advance or be given a month’s supply at the previous rate.

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Costs

For your Part D coverage, you will need to pay monthly premiums. These will vary between companies, but there is a national base premium.

For each medication you fill at the pharmacy, you will need to pay a copayment. The amount of your copayment will depend on what type of drug you are taking. Your plan sorts drugs into tiers based on whether they are generic, brand-name, preferred, or specialty. A preferred, generic drug will have the lowest copayment and a specialty drug will have the highest copayment.

Enrolling in Part D

You can enroll in Part D during your Initial Enrollment Period when you first sign up for Medicare. To choose a Part D plan, compare the formularies of the plans in your coverage area. Once you make sure your medications will be covered, you can compare the prices each plan will charge when you fill the prescription.

If you want to join, switch, or drop a Medicare Part D plan, you can do so during the Open Enrollment Period from January 1 to March 31 of each year.

You want to maintain creditable prescription drug coverage in order to avoid a late enrollment penalty when you sign up for Part D. The late enrollment penalty adds 1% of the national base premium for each month you went without Part D or creditable drug coverage.

For help in finding the Part D plan that has the coverage you need, contact Almond Insurance today at 815-494-4399!