Medicare Prescription Plans (Part D) Insurance

Medicare has added coverage for prescription medicines. This prescription drug coverage is insurance that covers both brand name and generic prescription drugs at participating pharmacies all across the nation. This means that people who have Medicare are able to get insurance to pay for part of their prescription drugs. Medicare is working with insurance companies to offer this benefit. It is available regardless of your income, illnesses, or drug costs.

You can sign up or change your plan between November 15 and December 31 each year. Your coverage will begin on January 1 of the New Year. However, you can enroll anytime of the year when you first become eligible for Medicare. You should enroll this year if you are eligible, or you may have to pay more in the way of a penalty if you decide to join later.

Whether you have Medicare alone, or in addition to, a group or secondary insurance coverage, you can choose any plan offered in your area that fits your RX needs. You may then compare new plans each year and change to any plan of your choosing that is available in your area.
Every Medicare recipient eligible should join the program unless you have “Credible” coverage. What is meant by “credible” is this: Any Prescription Drug Coverage which is at least as good as or better than the Medicare plan being offered. Examples of this would be some group coverages, VA benefits, and any state or federally backed programs such as PACE / PACENET.

Because private insurance companies are setting up these prescription plans, each company’s plans can and will be a bit different but they must follow the 4 basic stages of coverage that Medicare has set forth. These “stages” are triggered by dollar amounts of either a recipients out-of-pocket expenses or the totals of the drug cost limits set forth by the plan, whichever comes first. The amounts can change each year however the basic format remains the same. The first stage is a deductible, the second stage is a cost share or percentage, the third is considered the “donut hole” due to lack of coverage and the last stage is catastrophic coverage which drops your out of pocket cost considerably.

Some plans encourage you to use certain pharmacies and others may not cover all of your drugs. The cost of co-pays may also vary greatly. You must consider all the available plans in your zip code area and what they will cover. Some insurance companies offer “all-in-one” plans, which provide credible Part D coverage as well as health benefits. These “Medicare Advantage Plans (MA-PD)” as they are known can be more restrictive with fewer options for a RX plan that is right for you. It is important to review all your options and pick a plan that meets your needs.

Medicare has information that can help you compare the plans. You can get this information at www.medicare.gov or 1-800-MEDICARE (1-800-633-15026). You can also fill out our online Part D Prescription Plan online. Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan and area. If you have limited income or resources, and you qualify for extra help, you may not have to pay a premium or deductible. Otherwise, along with a monthly premium, you will also pay a part of the cost of your prescriptions, including a co-payment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium.