Did you know that your regular Medicare won’t cover outpatient medications that you pick up at the pharmacy? You may need to enroll for Medicare Part D prescription coverage before your window of opportunity closes!
We’ve created five considerations to help you make the best choice for you. Keep reading to find out if Part D coverage is right for you.
1. What is Medicare Part D Coverage?
In 2006, Medicare Part D prescription coverage was added to include outpatient prescription drugs. This Part D drug benefit which is also referred to as Medicare Rx helps those on Medicare to pay for outpatient prescription drugs.
This includes drugs that you purchase at retail, mail order, home infusion, and/or long-term care pharmacies. Meaning any prescription outside of a hospital stay or administered directly by your doctor is only covered under Medicare Part D.
2. What Makes Part D Different?
There are some significant differences between Part D vs. Part A and B. The Medicare Part A and B coverage is given by Medicare itself. Whereas Part D is considered privatized.
This means that Medicare creates contracts with private companies if they are authorized to sell Part D insurance coverage. The companies are all regulated and subsidized by medicare to ensure they are trustworthy. The contracts are renewed annually.
Each Part D plan must cover at least two commonly prescribed drugs. Keep in mind that if your medication isn’t covered by the plan, it may still cover a generic medication that is similar to your prescription.
3. How Can You Get Medicare Part D?
If you have Medicare and would like to include Part D coverage then you must enroll in a plan from one of the companies contracted with Medicare. There are additional costs to have Medicare Part D which includes a monthly premium.
You may also have an annual deductible, co-payments, and co-insurance for certain medications. Be sure to read the plan in detail since there are gaps in coverage and you may have to meet your deductible before catastrophic coverage kicks in.
4. What Are Your Options?
There are two ways to get your Medicare coverage. Be sure to weigh your options before choosing one or the other.
Original Medicare
The Original Medicare combines the Part D prescription drug plan (PDP) as a stand-alone with the Original Medicare coverage of A and B. This is the coverage that includes doctor and hospital services.
Medicare Advantage
The second way to get Part D is through a Medicare private health plan that includes all benefits under the same plan. This means you get the doctors, hospitals, and drugs under one private plan (MA-PDP). The downside is an additional monthly premium for medical benefits.
5. Is There Low-Income Help?
If you qualify as a low-income individual then you may be able to get help with Part D costs including premiums, deductibles, and co-pays. Check the Part D Low Income Subsidy (LIS) or Extra Help which is available through the Social Security Administration.
Consider taking time to compare different companies and their rates before purchasing a plan. Not all plans will cover your specific medications. Plus, the cost of plans can vary greatly from company to company. You may also want to consult with a health insurance consultant or broker.
Can You Enroll for Medicare Part D?
We hope this information will help you make an informed decision about enrolling for Medicare Part D. Keep in mind that there are specific times of the year and circumstances that allow you to enroll for coverage. Enrolling outside these terms can result in additional fees.
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