One of the faults of Original Medicare is that it has no coverage for prescription drugs. So all the seniors transitioning from their health coverage to Medicare once they reach age 65 have to find a way to afford their medications. Fortunately, separate Medicare Part D plans are available for prescription drug coverage.
As we age, many of us need prescription medications to control conditions or reduce the risk of developing a more serious illness. The sticker price of many drugs is prohibitive, so all those who regularly take medication should consider a plan with prescription drug coverage.
What is Part D?
Part D prescription drug plans are standardized by Medicare. Each plan has its own list of covered drugs, called a formulary. The drugs are sorted in tiers based on the copayment they require at the pharmacy. Generic drugs have the lowest copayment, followed by brand-name, non-preferred, and specialty prescriptions.
Is my drug covered by Part D?
Every plan covers at least two drugs in the most commonly prescribed categories. Essentially all drugs in these six categories are covered: antidepressants, antipsychotics, anticonvulsants, antiretrovirals, immunosuppressants, and anticancer. Generic and name-brand options should be available.
If you are prescribed a drug that is not covered by your plan, and it cannot be substituted by a drug on the formulary, you and your prescriber can request an exception. This can also be done if you need a drug in a higher quantity above the formulary’s quantity limit.
Are there alternatives to Part D?
Another way to get prescription drug coverage is by choosing a Medicare Advantage plan. These plans cover Medicare Part A and Part B, and many also offer prescription drug coverage. The advantage to this option is that everything is in one package. Not all drugs may be covered, so it is important to be aware of the benefits of each plan.
Each year, plans will send out a letter called the Annual Notice of Change. This will notify all members of changes to the coverage, including if any drugs will be substituted, added, or removed. These letters come out before the Annual Election Period from October 15 to December 7, allowing people to make informed choices about their coverage plans. Check your notice every year to make sure that your prescription drugs will still be covered, and if they will no longer be covered, shop for a different plan that affordably caters to your needs.
To learn more about Part D plans, give Hitcho Insurance a call today!
