Understanding Medicare Part D Coverage and Enrollment Options

There are two ways to get prescription drug coverage through Medicare. One way is with Part C coverage, which is available through a PPO or HMO plan. These plans offer the same benefits as Part A and Part B coverage as well. Part D coverage is used separately from Original Medicare or PFFS plans and a few other types. A Part D plan only covers prescription drugs. Participants can enroll in Part D plans by mail, by phone or online. If a person is enrolled in a Medicare Advantage plan or Part C and enrolls in Part D, that individual will be removed from Part C coverage and returned to Original Medicare.

What Part D Covers Every prescription drug plan from Medicare has a list of covered drugs. Prescription drugs are placed in separate tiers based on their prices. Low-tier drugs usually cost less than drugs in higher tiers. There may be instances where a prescriber insists that a patient use a high-tier drug instead of a low-tier alternative. If this is the case, it may be possible to ask for an exception and have a lower copay obligation. Formularies may change each year based on Medicare’s guidelines. When changes involve a currently used drug, the plan must provide written notice of the change 60 days before the change takes place. Notification may be made by direct contact or when a patient requests a refill of the affected drug.

Part D Cost and Enrollment There is an annual deductible that must be met. In addition to this, policyholders pay a premium and any coinsurance costs. There may also be costs for extra help, late enrollment and coverage gaps. Drug plans vary in price depending on the plan, whether the patient uses in-network pharmacies, the drugs used and whether the patient receives extra help. While plan participants do not have to enroll in Medicare again every year, there are certain time frames when initial enrollment and changes are permitted.

Part D with Other Coverage Some people have existing plans with companies other than Medicare. When there is an existing plan with another company, it is best to consider the benefits of both before switching. For government health insurance such as VA benefits, federal employee benefits, Tricare or Indian health benefits, it is best to keep federal coverage. Contact any programs used such as food stamps, HUD or SSI to see how Medicare works with benefits.

People who are newly eligible for Medicare should start planning their enrollment as soon as possible. It is important to be aware of the open enrollment period where changes and initial enrollment are allowed. To learn more about Medicare Part D plans and what options are best for individual needs, discuss concerns with an agent.

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