Medicare Prescription Drug Plans

Medicare prescription drug coverage, also known as Medicare Part D, helps cover the cost of eligible brand-name and generic medications. This coverage is offered by private insurance companies approved by Medicare.

You can receive Medicare drug coverage through:

• A stand-alone Medicare Part D plan that works alongside Original Medicare
• A Medicare Advantage plan that includes prescription drug coverage

Each plan has its own list of covered medications, known as a formulary. Plans may also differ in premiums, deductibles, copayments, pharmacy networks and coverage requirements.

To enroll in a stand-alone Medicare prescription drug plan, you must generally have Medicare Part A or Part B. You pay the plan’s monthly premium and may also be responsible for a deductible, copayments or coinsurance when filling prescriptions.

Medications are commonly placed into different pricing tiers. Generic drugs may be placed in a lower-cost tier, while preferred brand-name, non-preferred or specialty medications may be placed in higher-cost tiers.

The amount you pay can depend on:

• Whether your medication is covered by the plan
• The pricing tier assigned to your medication
• Whether you use an in-network pharmacy
• Whether the pharmacy is preferred by the plan
• Whether the medication requires prior authorization
• Whether quantity limits or step therapy requirements apply

Because coverage and costs vary between plans, reviewing your complete medication list before enrolling is important.

Prescription drug plans can change their premiums, covered medication lists, pharmacy networks and cost-sharing amounts from one year to the next. Your own prescriptions may also change as your healthcare needs develop.

A plan that worked well for you last year may not provide the same value this year. Reviewing your coverage can help confirm that:

• Your current medications are still covered
• Your preferred pharmacy remains in the network
• Your prescriptions have not moved to a more expensive tier
• Another available plan does not offer better overall value
• You understand any new coverage requirements

The plan with the lowest premium may not always have the lowest total cost. Your expected prescription expenses should also be considered.

You can generally enroll in Medicare prescription drug coverage when you first become eligible for Medicare. You may also join, switch or drop a plan during certain Medicare enrollment periods.

Medicare’s Annual Open Enrollment Period runs from October 15 through December 7. Coverage selected during this period generally begins on January 1 of the following year.

Special Enrollment Periods may also be available after certain qualifying situations, such as losing other creditable prescription drug coverage or moving outside your current plan’s service area.

Waiting to enroll after becoming eligible may result in a late enrollment penalty if you go without creditable prescription drug coverage for the applicable period. This penalty may be added to your Part D premium for as long as you have Medicare drug coverage.

Choosing a prescription drug plan should begin with the medications you use, the pharmacies you prefer and the total costs you may pay throughout the year.

Effective Insurance Solutions can help you review Medicare prescription drug plans offered by the insurance companies we represent and explain your available options in clear language.

Call Effective Insurance Solutions at (956) 687-1717 or contact us to schedule a professional consultation.