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How to get Medicare Part D drug coverage?

Generally it is a good idea to get drug coverage when you are first eligible because if you do not, you may pay a late enrollment penalty. You can only avoid a late fee if you either take advantage of the Extra Help program or have other credible prescription drug coverage from a union or employer.

If you do not know if you are going to be assessed a penalty, Medicare will let you to know what the penalty is and what amount you need to pay for your premium. Typically, the penalty is then paid as long as you have a Medicare drug plan. Therefore, it is important to know the deadline of enrollment and do so on time in order to avoid penalties.

There are two ways for you to obtain prescription drug coverage. One way to do this is through a Medicare Prescription Drug Plan Part D, which adds drug coverage to the original Medicare; some Medicare Private Fee-for-Service plans; Medicare Medical Savings Account plans; or some Medicare Cost plans. The second way to get coverage is through a Medicare Advantage Plan Part C where patients get all of Medicare Part A (hospital), Medicare Part B (medical), and Part D (prescription drugs) in this plan. Those who enroll must have Part A and Part B to be in a Medicare Advantage Plan (MA-PD).

Here are the four ways to join a drug plan:

• enroll on the Medicare Plan Finder at: https://www.medicare.gov/find-a-plan/questions/home.aspx
• enroll on the individual plan’s website
• fill out a paper enrollment form
• call the plan of choice
• call 1-800-MEDICARE (1-800-633-4227)

Note: Joining a Medicare drug plan, may impact your Medicare Advantage Plan (Part C) and you will revert back to Original Medicare if you join a Medicare Prescription Drug plan (Part D) and if your Medicare Advantage Plan included coverage for prescription drugs.

What happens when a person reaches the Medicare Part D deductible?

It is important to understand that not all patients have an annual deductible, so the observations in this post refer only to those who do pay a deductible. Once that deductible limit has been reached, what usually happens is that the patient then has to pay a co-insurance or co-payment for every prescription. Co-payments are typically a fixed dollar amount. Co-insurance payments have the individual pay a percentage of the total cost of the drug.

Medicare Part D also has what is referred to as catastrophic coverage. If a patient’s annual out-of-pocket reaches $4,950 (2017), only a small co-payment or co-insurance amount is paid for all covered drugs for the balance for the year.

If you qualify as low income Medicare Part D has an Extra Help provision that may help an individual or family reduce drug costs even more. Those who qualify do not pay more than $3.30 per covered generic drugs or $8.25 for a brand name covered drug.

Want to find your level of possible Extra Help? Visit the Medicare website at: https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html

How much is Medicare Part D?

Medicare Part D costs vary greatly from one individual to the next. Expenses, per person, change in response to the drug used, the drugstore filling it out, the type of plan and if the person qualifies for Medicare’s Extra Help program. The Extra Help program helps people with low incomes pay prescription drug program costs like premiums, deductibles and co-insurance fees.

Medicare Part D costs vary because all the Part D plans have their own terms and rules for the policies offered. All plans are required to offer minimum coverage that then can be built on with additional offers. For example, some plans will provide tiered systems where only some brand-name drugs are less expensive.

Nonetheless, there are some common features to be found in all Part D Medicare Plans. For instance, most individuals pay a monthly premium that increases with the person’s salary. All patients do not pay the monthly premium and this is applicable when it comes to deductions. Many Part D Medicare plans charge an annual deductible prior to coverage becoming effective. Deductibles are different for each plan. For 2017, Medicare has stated the maximum deductible is $400.00.

What does Medicare Part D cover?

Medicare Part D requires clients to buy plans from a private insurance company. That means that each insurer offering Part D has its own list of covered drugs, the plan formulary.

In order for each insurance company to be able to provide information to potential and existing clients, they break the drugs into various tiers with differing costs. Thus, the drugs in the lowest tier generally have a lower co-insurance or co-payment cost and vice versa — higher-cost drugs usually have a higher co-insurance or co-payment price. There is an exception to this rule, however, if a doctor wants a patient to take a drug in a higher tier, it is possible for patients to obtain the drugs at an affordable price.

The formulary usually stays the same during the year, but it is possible for a plan to change coverage providing it follows Medicare’s rules and regulations. Patients affected by such a change must have at least 60 days’ notice before changes go into effect. Additionally, a refill request must be honored, plus the patient is offered a 60-day supply under the previous plan before changing to the new plan.

Interested in finding out what drugs are covered in your area? Check out Medicare’s plan finder tool at: https://www.medicare.gov/find-a-plan/questions/home.aspx