Medicare Part D – Medicare Prescription Drug Plan

HIGHLIGHTS:
    -> What is Medicare Part D 
    -> What is the purpose of Medicare Part D
    -> Does Medicare Part D have out-of-pocket cost
    -> What are a formulary and it’s Tiers
    -> When do I sign up for Medicare Part D
    -> Final Take Away



WHAT IS MEDICARE PART D

Medicare Part D is known as Medicare Prescription Drug Plan (PDP).

You can get Medicare Prescription Drug Plan in 2 ways: 1) as a stand-alone and in addition to Medicare Part A and Medicare Part B; or 2) in a Medicare Advantage plan called Medicare Advantage Prescription Drug Plan (MAPD).

MEDICARE ADVANTAGE DRUG PLAN (MAPD)

The Medicare Advantage plans are great options for Medicare beneficiaries that want to receive extra benefits with Medicare beyond what Medicare Part A and B provide and may include Prescriptions Drugs, these Medicare plans are known as MAPD.

When you sign up for Medicare, you will be required to sign up for Medicare Part D (unless you qualify for a Medicare waiver). If Medicare beneficiaries in your family do not receive prescription drug coverage through their employer or other health insurance plan, it is highly recommended that they enroll in Medicare Part D since the deductible can be expensive especially if someone has several prescriptions they need each month. When you enroll in Medicare stand-alone Prescription Drug Plans (PDP) or Medicare Advantage plans with prescription drug coverage, this will cover most of your prescription needs so long as it is covered under Original Medicare.

Medicare Advantage plan members may receive coverage for annual physical, free flu shots, discounts on vision and dental care, gym memberships, hearing aids, prescription drug coverage for generic medications not covered under Medicare Part A or B, as well as copays at the doctor’s office.

There are 4 parts to this program: Medicare Part A, Medicare Part B, Medicare Advantage (Part C), and Medicare part D. Medicare part D is by far the most important of the 4 parts in regard to medication because it will provide you with your prescription drug coverage. Medicare parts A and B do not give any coverage for prescriptions so they are necessary to be enrolled in the Medicare part D plan. There are two ways people can be enrolled in Medicare part D. They can either enroll by visiting the Medicare website, or they could visit their local Medicare office to fill out an application form. Here at Your Medical, we will make sure to help you sign up for all the correct plans, including Plan D!

WHAT IS THE PURPOSE OF MEDICARE PART D

While there are many Medicare Advantage plans available in today’s market there is one aspect of Medicare that people often overlook which is the Part D Prescription Drug Coverage. The Medicare Part D program was launched by the government in 2006 through private insurance companies to achieve more equality among all people receiving Medicare. Medicare Part D provides Medicare beneficiaries access to prescription drugs and it does not matter if you receive Medicare through Medicare Advantage or Medicare supplement. Medicare Part D will be available to every Medicare beneficiary no matter what plan they are on.

DOES MEDICARE PART D OR MAPD HAVE ANY COSTS

While Medicare Part D stand-alone plan may require beneficiaries to pay out-of-pocket expenses such as premium, deductible, co-payments, or if you chose a Medicare Advantage Plan that includes prescription (MAPD) you will with some out-of-pocket expenses but no premiums. The specific amount of out-of-pocket expenses vary from plan to plan which is why it is important to speak to a licensed Medicare professional. When you sign up for Medicare, you will be presented with an option to enroll in a Medicare stand-alone Prescription Drug Plan (PDP) or a Medicare Advantage plan with prescription drug coverage (MAPD) based on your needs and budget. The list of covered prescriptions can be found in the formulary of the plan. The list of prescriptions is known as your plan formulary.



WHAT IS A FORMULARY AND ITS TIERS

A formulary is a list of prescription drugs covered by a prescription drug plan offering prescription benefits. Many drug plans have different levels called tiers on their formularies, each tier has a different cost. This is an example of the different types of tiers: Tier (1); Tier (2); Tier (3); Tier (4) each tier has a different cost for the prescription and the lower the tier typically the less cost. However, you must look at the actual plan for the specifics of the drugs.

When you start receiving benefits and paying your monthly premiums on your Medicare Advantage plan, this will also allow you to receive your co-pay amounts at the doctor’s office as well as other discounts available through Medicare such as discounted eye exams and hearing aids among others. Medicare Part D is available to Medicare beneficiaries who are enrolled in Medicare A and B. Medicare Part D also provides Medicare beneficiaries with discounts on generic prescriptions through Medicare.

WHEN DO YOU SIGN UP FOR PLAN D

Part D also helps make receiving prescription drugs more affordable for Medicare beneficiaries by giving them coverage in the coverage gap. The “coverage gap” is a period of time where certain Medicare beneficiaries may have to pay more for their prescriptions. This is because during that time some insurance companies only offer partial coverage on some medications, leaving you with a bigger bill at the pharmacy until your deductible has been satisfied. Once this happens though, an individual usually benefits from lower cost-sharing as well as new Medicare benefits such as yearly wellness. If you are currently not enrolled in Medicare part D plan and wish to be, it is important to sign up for Medicare as soon as possible, (Open enrollment is from Oct. 15 – Dec. 7) or as soon as you lose creditable coverage either from an employer or labor union. Some people may think that Medicare Part D isn’t necessary if they don’t take any medications which are why many leave it alone even though other parts of Medicare are severely lacking. However, what most people don’t realize is that many free programs are available through the coverage gap that acts as a safety net, that may not have been available otherwise.

FINAL TAKE AWAY

Medicare part D will be your most essential Medicare plan, so it is very important to sign up for Medicare when you are first eligible. Medicare part D is also very easy to enroll in because all people have to do once they have Medicare part A or B, is visit the Medicare website or their local Medicare office and fill out an application form for Medicare Part D. For any additional questions regarding Medicare plans please feel free to call us at Your Medical.

IMPORTANT: IF YOU DO NOT SIGN UP FOR PART D WHEN YOU WILL BE PENALIZED! (THIS COMPLETED TOPIC WILL BE COVERED IN ITS OWN ARTICLE)

There are many Medicare part D plans available to choose from that do not cost much money at all so it is important to be aware of what your Medicare plan offers, and how much it will cost you each month. When shopping around for the perfect Medicare Advantage Plan it is essential to include Medicare Part D in your decisions because without this Medicare part you won’t receive any coverage at all!

I work for YourMedicare and we help Medicare patients enroll in Medicare Advantage plans, including the Prescription Drug plan Medicare Part D. If you would like to learn more about how we can help you, please visit our website www.yourmedicarecoverage.net today! Our knowledgeable agents are available anytime to answer any questions you may have regarding Medicare part D or Medicare Advantage Plans so feel free to give us a call at 1-800-381-3623. Thank You!

-YourMedicare Staff Writer – Erikanthony Salazar