Medicare Part D

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Prescription Drug Coverage

Medicare Prescription Drug Plans provide some insurance coverage for brand name and generic prescription drugs. Medicare works with insurers and other private companies to offer many different plans. To get a Medicare Prescription Drug Plan, you must already have Medicare Part A and/or B. There are many different plans to choose from.

How a basic Part D plan works:

Each month, you pay a monthly fee—or premium—for your Part D prescription drug plan. The premium varies from plan to plan. The Medicare advisors at Senior Solutions of Missouri can assist you in enrolling in the Part D plan that is best for you.

If you don’t sign up for Part D when you’re first eligible, or if you drop Part D and then get it later, you may have to pay a late enrollment penalty for as long as you have Part D. The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage.

You may also be required to pay a yearly deductible. The yearly deductible is the amount you pay for your prescriptions before the plan begins to pay. Some plans do  not have a deductible. After you have paid the deductible out of your own pocket, your Medicare Prescription Drug Plan kicks in.

Then, when you buy medications, you pay part of the costs, and your plan covers the rest of the costs. Your share may be a flat fee, called a co-pay, or a percentage of the cost of the drug, called co-insurance.

In many plans, there is a coverage gap after you reach a spending limit. This is the “donut hole.” After the total cost of your drugs (what you and your insurer paid combined) reaches a certain level—combined amount plus deductible—Medicare stops paying. You have to start paying your drug costs on your own—$2,960 in 2015.

Remember that Medicare Prescription Drug Plans vary a great deal. Once you sign up, it might be a year before you can make changes. So be very careful when choosing a plan. Here are some things to consider:

  • Make sure that the drugs you need are covered by the plan.
  • Be thorough and check out all the details. Your prescription may be listed, but the dosage you are prescribed may not be covered.
  • You may be required to obtain prior authorization for a prescription drug before it is covered.
  • If drugs you need aren’t listed, talk to your doctor. Your doctor may be able to prescribe a similar medication that will work just as well.
  • Compare the costs. The deductibles, premiums, and co-pays/co-insurance for plans will be different.
  • Check the pharmacies. Some plans will only work with certain pharmacies. It is important to make sure that your current pharmacy—or another one nearby—is listed.
  • Many plans will allow you to have your prescription drugs delivered by mail.

Some people with low incomes and limited assets are given Extra Help to pay for their Medicare Prescription Drug Plan. If you qualify, you may not have to pay the monthly fee and your co-payments will be cheaper when you buy drugs. These plans do not have a coverage gap, or “donut hole.”

Since the Prescription Drug Plans change each year, Senior Solutions of Missouri provides a free, annual review of your Prescription Drug Plan to ensure that you continue to be on the best drug plan, based on the medications that you take.