It may come a surprise to you that Medicare does not exactly provide coverage prescription drugs. As one gets older in aged, 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 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.
What Medicare Drug Plans Do and Do Not 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. 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 appeals process in case of denial. Despite that limitations in coverage, many Medicare Part D plans cover more than just the standard plan. Some plans are 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 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 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 www.socialsecurity.gov (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.