MEDICARE PART D
Medicare Part D Plans – Understanding The Basics
Coverage for prescription drugs is offered through a Medicare Part D stand-alone plan or through a Medicare Advantage Plan (Part C). Medicare Part D Plans and Medicare Advantage Plans are run by insurance companies or other private companies whom Medicare has approved.
Even if you are not taking any medication when you enroll for Medicare, you should make a drug plan part of your Medicare enrollment. If you do not select a Medicare prescription coverage plan, and a physician prescribes medication for you, later on, Medicare will probably charge you a penalty for late enrollment.
How Medicare Drug Coverage Works With Other Insurance
It’s important to remember that Medicare drug coverage is a supplemental part of your health coverage. These plans are designed specifically to work in conjunction with any other Medicare or health coverage that you may have. Here’s how Medicare drug coverage works with other insurance plans and programs.
Union or Employer Health Coverage
If you have drug coverage from an employer, they will notify you annually to let you know about the credibility of your drug coverage program.
COBRA
If you have a COBRA plan that includes creditable drug coverage, you will be able to join a Medicare plan during a special enrollment period for your prescriptions when your COBRA ends.
Medigap Policy With Prescription Drug Coverage
Prescription drug coverage cannot be sold with Medigap policies anymore. However, if you are a current subscriber to a Medigap policy with drug coverage, you can keep it. Your Medigap insurance plan will need to remove your drug coverage and adjust your premiums when you sign up with a prescription plan with Medicare.
When Can You Enroll In Medicare Part D?
To enroll in a Medicare drug plan, you must first be enrolled in Medicare Parts A and B. There are three times when Medicare Part D enrollment is permitted. These are:
1. Initial Enrollment Period
This is the first eligible Medicare part D enrollment period and begins three months before the month of your 65th birthday and continues for three months following your birthday.
2. Open Enrollment
An annual open Medicare Part D enrollment period that runs from October 15 through December 7.
3. Medicare Part D Special Enrollment Period
Under certain conditions, you may be allowed to enroll in a drug plan during the Medicare Part D Special Enrollment period.
Your circumstances will dictate when Medicare Part D enrollment works for you, but keep in mind that there may be penalties for late enrollment.
Types Of Medicare Part D Plans
Each Medicare Part D stand-alone plan varies in premium costs, drug costs, and drugs covered. Drugs are listed and categorized into a tier structure. Drugs in higher tiers generally cost more than drugs in lower tiers. Coverage Rules May Apply:
- Prior authorization for certain prescriptions.
- Quantity limits for the amount of medication you can get at a time.
- Step therapy which means you must try lower cost drugs first.
- Your Medicare Part D may waive any of these coverage rules if you or your provider request an exception.
If a Medicare Part D drug plan makes any changes involving a drug you are taking, they must provide written notice to you of the change 60 days before the change becomes effective.
Vaccines not covered under Medicare Part B must be covered by Medicare Part D plans if they are necessary to prevent illnesses. Drugs received in a hospital setting such as an emergency department may be considered out-of-pocket costs. You can submit a claim for a refund to your Medicare Part D plan.
You will have to get approval from Medicare Part D if you get your drugs through an automatic refill delivery service. Some Medicare Part D plans require approval for every delivery and some only require approval once a year.
A Medicare Part D stand-alone plan adds drug coverage to traditional Medicare, as well as some other plans approved by Medicare, such as Medicare Cost Plans, Medicare Private-Pay-For-Fee-Service Plans, and Medicare Medical Savings Account Plans. These Medicare Part D options are available through insurance companies and other private companies.
Stand Alone Part D
A Medicare Part D Prescription Drug Plan (PDP) is a stand-alone plan. A Medicare Part D stand-alone plan only covers prescription drugs. There is no other health care coverage in a stand-alone Medicare Part D Prescription Drug Plan (PDP).
Medicare Advantage Drug Coverage
A Medicare Advantage Plan with drug coverage (MAPD) includes both prescription drug coverage and other health care coverage. Most Medicare Advantage plans cover prescription costs.