Medicare Rx

A Medicare Prescription Drug Plan provides insurance coverage for prescription drugs. When you buy this type of insurance you’re buying value and security because you are protecting against the unknown.

Like other insurance, if you join a Medicare drug plan, there is a monthly premium. Costs will vary depending on the drug plan you choose. If you have limited income and resources, you may get extra help to cover prescription drugs for little or no cost. The amount of the monthly premium is not affected by your health status or how many prescriptions you need. You will also pay a share of the cost of your prescriptions. All drug plans will have to provide coverage at least as good as the standard coverage, which Medicare has set. However, some plans might also offer more coverage and additional drugs for a higher monthly premium.

If you have limited income resources, you may be able to get help with drug plan costs. With prescription drug plans, you must choose a plan and enroll, you are not automatically enrolled. If you do not enroll in a Part D plan during your initial enrollment period, you could pay a penalty later.

Anyone who is entitled to Medicare Part A or enrolled in Part B is eligible to join. The individual with Medicare also has to live in the service area of the Prescription Drug Plan or Medicare Advantage Prescription Drug Plan to join that plan. You must continue to pay your Medicare Part B Premium if not otherwise paid for under Medicaid or by another third-party.

Under Part D, people with Medicare will have a choice of at least two plans – drug-only coverage offered by a private plan that contracts with Medicare OR a Medicare-approved HMO or PPO that provides both drug coverage and other health care services (Medicare Advantage – Prescription Drug Plan)

The prescription drug coverage option you choose affects:

Coverage: Medicare drug plans will cover generic and brand-name drugs. Plans may have rules about what drugs are covered in different drug categories. This makes sure people with different medical conditions can get the treatment they need.

Most plans will have a formulary, which is a list of drugs covered by the plan. This list must always meet Medicare’s requirements, but it can change when plans get new information. Your plan must let you know at least 60 days before a drug you use is removed from the list or if the costs are changing.

If your doctor thinks you need a drug that isn’t on the list, or if one of your drugs is being removed from the list, you or your doctor can apply for an exception or appeal the decision.

Convenience: Drug plans must contract with pharmacies in your area. Check with the plan to make sure the pharmacies in the plan are convenient to you. Some plans also allow you to get your prescriptions through the mail.

Medicare Drug plans will have an annual enrollment period which allows you to re-evaluate your prescription needs and make changes. You can enroll in a new plan from November 15th – December 31st for the plan to become effective on January 1 (most carriers require the applications to be received prior to December 31st).