PRESCRIPTION DRUG PLAN
So you’re 65 or over and enrolled in original Medicare or you’ve opted to get into a private Medicare Advantage Plan. How do I obtain my prescription drugs? Medicare offers prescription drug coverage to everyone with Medicare. You will pay for Part D (drug plan) in addition to what you pay for Parts A and B. If you have trouble with the cost, you may be able to get financial aid, called “Extra Help”.
Two ways to obtain coverage:
All these parts, plans how do I keep it straight? Think of Part D as “DRUGS” (Sometimes called PDP’s) it’s an add-on coverage to “original Medicare” some Medicare Cost Plans, some Medicare Fee-for-service Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Advantage Plan (Similar to HMO or PPO) that offers prescription drug coverage. Think of Part C as “COMPLETE”. You get all of your Medicare Part A (hospital coverage) and Medicare Part B (Medical Coverage) and prescription drug coverage (Part D “Drugs”) through the Medicare Advantage Plans. Here’s where it can get confusing, You must have Part A and Part B of Medicare to join a Medicare Advantage Plan. We will talk about the pros and cons of these plans in future blogs. Generally, these plans have very limited availability in the geographical areas offered to us in the Central Coast of California. Further, the network of providers is much smaller than “original Medicare”
Which drug plan should I choose?
There are over a hundred drug plans to choose. Selecting a drug plan is tailored to your specific needs. It’s important you take the time to choose wisely. Many people have made the mistake of selecting a company that they have heard on the radio or TV, or paired up in a plan with their spouse, only to find they are paying much higher premiums and co-pays than was necessary. Folks, this can cost you hundreds of dollars each year. This can be easily remedied by consulting your health insurance agent during Open Enrollment (October 15 though December 7th) each year or you can enroll on the Medicare Plan Finder located on Medicare.gov. This is an amazing tool that will locate the medications you require to include your dosage and frequency with a summary of premiums and co-pays for the year.
Joining is easy. If you don’t feel comfortable using the computer and enrolling on line you can:
• Enroll with a licensed agent
• Complete a paper enrollment form.
• Call the plan carrier.
• Call 1-800-MEDICARE (1-800-633-4227).
When you join a Medicare drug plan, you’ll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.
Does your plan cover all your medication?
Make sure the drugs you need are on the plan’s drug list, called its formulary. A drug plan won’t help pay for medicines that aren’t on its list. Check the details carefully. Even if a drug is on the formulary, look closely to make sure it’s covered at the dose and amount you need. Also, look to see if you must get your doctor’s approval before the plan will pay for the medicine.
Prescription drug costs have many variables. No two plans are the same. Here’s what to look for:
- The plan you choose
The drugs you use
Whether you go to a pharmacy in your plan’s network
Whether the drugs you use are on your plan’s formulary
Weigh your options carefully. Once you sign up for a plan, you may not be able to make changes for a year.