As you may know, Original Medicare includes Part A (hospital) and Part B (outpatient) coverage. However, it does not include drug coverage, which most people consider essential. To get a prescription drug plan (Part D), Medicare members must purchase coverage from private insurance companies.
Who Is Eligible for Prescription Drug Coverage?
If you qualify for Medicare, you also qualify for the drug benefit (Part D). You must enroll in Part A and/or Part B to join Part D. The initial enrollment period lasts seven months. It begins three months before your 65th birthday month and ends three months after.
Medicare drug coverage is only available through private plans. If you have Part A and/or Part B but no drug coverage, you should enroll in Part D—even if you don’t take prescriptions now. Delaying enrollment will cause a lifetime penalty if you need coverage later.
How to Obtain a Prescription Drug Plan
There are two main ways to get drug coverage:
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Enroll in a “stand-alone” Prescription Drug Plan (PDP). These plans add drug coverage to Original Medicare. If you have a Medicare Supplement plan, you’ll likely need to add a PDP, since Medigap does not cover drugs.
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Choose a Medicare Advantage Plan with prescription drug coverage (MA-PD). These plans bundle Part A, Part B, and Part D into one package. You must have both Part A and Part B to join an MA-PD.
How Much Does Part D Cost?
Your actual cost depends on:
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The drugs you take
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The plan you choose
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Whether your pharmacy is in-network
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Whether your prescriptions are on the plan’s formulary
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Whether you qualify for Extra Help with costs
Each plan has its own formulary, or list of covered drugs. Drugs are grouped by tiers. Tier 1 usually includes generics, while Tier 5 contains specialty drugs. In general, you’ll pay a monthly premium, an annual deductible, and copayments or coinsurance for certain drugs.
Choosing the Right Plan
The best way to pick a drug plan is to start with your priorities. Remember, prescription drug plans change every year. That’s why it’s important to meet with a trusted Medicare agent annually to review your plan. We recommend working with a local broker who can meet with you face-to-face. Insurance plans change each year, and your health needs will change too.
As Independent Brokers, we can review your prescriptions and find the lowest-cost plan available. Time spent with your local agent is time well spent. Contact us today at (540) 662-4432 to speak with Brian or another agent, or visit medicaretrustedagents.com for more information.
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