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Here is What You Need To Know About Medicare Part D Prescription Drug Plans Explained

It may come as surprise to you that Medicare does not exactly provide coverage prescription drugs. As one gets older in age, medical needs increase, with increased medical needs so does the need for prescription medication that a doctor is likely to prescribe.

Medicare is the federally managed low-cost health insurance program for senior citizens ages 65 and older. When enrolling in Medicare, you will receive Medicare part A as standard. While Part B is an option for extended Medicare, Part C for Medicare Advantage, and Part D for prescription drugs. Parts B through D are all optional categories. Even if you currently do not take any prescription medication as of now, the likelihood of you or your spouse needing prescription drugs in the future is highly likely. While is questionable as to why prescription drug coverage or part D is not included as standard in Medicare, there are many ways to receive prescription drug coverage.

The Broken Down Costs Of Medicare Part DImage result for medicare part d

Medicare Part D is more than just an optional add-on to your Medicare, rather it is entirely separate and even has it’s own enrollment process. Rather, Medicare Part D works like its own health insurance plan but strictly for prescription medication. Instead of a simple additional cost to your current Medicare plan, it has the same cost structure as a regular insurance plan. Here’s how it works:

    • Monthly Premium: How much you pay every month to have Medicare Part D coverage.
    • Deductible: How much you have to spend on prescription Medication before Medicare Part D pays anything
    • Coinsurance: A variable portion of what you pay each time you get prescription drugs.
    • Co-Payment: A fixed portion of prescription drug costs you pay in conjunction with Medicare Part D.

Here Is What You Need To Know About Medicare Part D And Prescription Coverage

Medicare Part D represents the prescription drug plans for all Medicare users. Someone who is on Medicare has a completely separate plan to deal with medication, but it does not handle all medications in the same way. You must understand how to use Part D prescription coverage in the right way, and you could find cheaper drugs if you receive assistance from the resource center. Look below at what happens when your Medicare Part D is used in a way that makes you healthier without costing so much money.


What Medicare Drug Plans Do Cover

Each Medicare Part D plan has a formulary, which is a set list of approved drugs that are specifically covered. A plan can make formulary changes at their discretion as long as the changes are approved by CMS and are posted on the drug plan’s official Web site at least 60 days before taking effect. Those already taking medication that is removed from the approved list may continue to have coverage for the drug until the end of the current year.

What Medicare Drug Plans Do Not Cover

Medicare Part D plans do not offer coverage nonprescription drugs, prescription vitamins, drugs for weight loss or weight gain, etc. While certain Part D plans may cover excluded drugs, these drug costs will not accumulate to meeting your maximum out-of-pocket limits. Even though some medications may not be covered those enrolled in Part D beneficiaries can request that a drug plan make exceptions to cover a non-formulary drug under unique circumstances. There is also an appeal process in case of denial. Despite the limitations in coverage, many Medicare Part D plans cover more than just the standard plan. Some plans have zero deductible, some do not have a coverage gap, and some also feature a tiered copayment structure. Medicare drug plans use a network of providers to dispense medications. All plans require walk-in pharmacies for purchasing prescription drugs but some may also offer mail-order options as well.

Enrolling In Medicare Part D

Medicare does have an enrollment period similar to open enrollment with the health insurance marketplace. The initial enrollment period is a 7-month period that includes the month of eligibility (when an individual turns 65 years old) and the three months before and after that date. Typically, an individual will first need to enroll in Medicare in general, then follow a separate enrollment for Medicare Part D if they choose not to purchase a Medicare Advantage plan (part C). An individual cannot be denied coverage because of income level or for the pre-existing health condition. However, be aware that if an eligible individual does not enroll in a Medicare Part D plan at the time of initial eligibility. There is a penalty unless the individual had prior creditable prescription drug coverage with no coverage gap of more than 63 days if prior coverage lapsed during that time.

How To Enroll In Medicare Part D

At the minimum, all Medicare Advantage plans must offer the same Medicare Part A and Part B benefits as Original Medicare. To get Medicare Part D, however, you must have Original Medicare, in order to enroll in a Medicare Advantage plan through a private insurance provider.

  • Determine Your Medical Needs Whether You Will Need Medicare Part A Only or Medicare Part B in addition to Part A.
  • Fill out an application in One Of Three Ways: Online at (there is an option where someone can help you fill out the application online if needed), Calling Social Security at 1-800-772-1213, OR Visit Your Local Social Security Office
  • Wait For Approval Of Medicare Part A
  • Once enrolled in Medicare Part A, Complete an Application for Enrollment in Part B (CMS-40B) if you choose to have Part B. Skip this step if you do not want Part B. NOTE: Sometimes you may automatically be enrolled, if so and you do not want Part B. Follow the instructions back or call Social Security.
  • Follow The Online Steps To Enroll In Medicare Part D.

Check The List Of Covered Medications 

The list of covered medications is typically very long, but they are usually covered at different levels. You might come across a medication that you believe should be cheaper, and the resource center might talk you through some generic brands that will work just as well. You could check the list of covered medications online, and you might take that list to your doctor when your next appointment comes up. Remember that your doctor could prescribe an expensive drug, and you must be prepared to ask for the generic that is not expensive.

Image result for medicare part d illustrationHow Does Part D Work In The Pharmacy? 

Part D works well in the pharmacy because the pharmacy typically has both the generic and the name brand drug. However, the pharmacy has to charge the list price for all these medications. The pharmacist does not have any control over these prices, and they are working for a much larger company that expects them to turn a profit. You might want to find another place to buy your medications, and these online pharmacies will still take Part D.

What Is An Online Pharmacy? 

Medicare Part D pays for the medications regardless of where they come from. The prescriptions that you get could be cheaper if you bought those drugs from an online pharmacy, and the online pharmacy tends to charge much less. They are in the discount business, and they will make certain that you get a lower price if you are filling your prescription for more than one month. You must contact the resource center if you want to be covered for multiple fillings in one month. Exceptions could be made, but it all depends on what you think is best for your health or schedule.

Faster Shipping 

The online pharmacy will typically charge little to nothing for shipping, and they will send your medications overnight if you are in a bit of a bind. They understand that you are saving a lot of money, and they offer shopping options that are better for your family. You might want to order from the online pharmacy online so that you are not dealing with a customer service associate, or you could call them to ask about how large your bottle could be.

How Does Part D Complete Your Claims? 

Part D will pay for all your medications if they are on the list, but you must be certain that those medications are not limited by monthly caps. You might be allowed to fill a prescription once per month, or you could have a yearly cap on a medication. Doctors might only fill a prescription once, and they could stop the refills if they think you do not need anymore. The purpose of the Part D plan is to pay out claims quickly, and you must have your Medicare card ready to present to any pharmacist. The company will file a claim with Medicare, and you are only sent a bill if the drug is not covered completely. Remember that you could save a lot of money using an online pharmacy, and they use the same procedures as the pharmacy down the street.

Drug Change Often 

You must check the drugs on the list because they could change from one coverage level to another or be removed completely. You might not have realized that the drug you use is not covered, or you could come across a generic that is much cheaper. Checking the list every month or so is good for your wallet, and you could change your prescription orders if you believe that is prudent. Switch to the generic when you find out it is on the list, or change medications entirely if your medicine has been removed from the list. There are many seniors using Part D every day, and they are all hoping that all their medications will be covered. These medications could be purchased from an online pharmacy that is meant to give you a discount, or you could order from your local pharmacy. There is a resource center that helps you get information on medications, and you might want to ask about certain drugs or generics before placing your order. Everything that you do is simplified when you know which drugs you can afford, where to get them cheaply, and what level they have been covered.

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