Prescription Drug Coverage

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Medicare Prescription Drug Benefit

The Medicare Prescription Drug Benefit is voluntary, but everyone should carefully consider enrolling in a Part D Prescription Drug Plan unless you have comparable (or better) drug coverage from another source (such as a current or former employer).

If you do not enroll in a Medicare Part D Prescription Drug Plan during the first 6 months you are eligible and you do not have comparable (or better) drug coverage from another source, you could pay a late enrollment penalty should you decide to enroll in a Medicare Prescription Drug Plan at a later time.

The Part D Prescription Drug Benefit is an insurance program and private companies under contract with Medicare provide the coverage. Because individuals have different needs and preferences, Medicare gives you choices for your outpatient prescription drug coverage.

Each Medicare Prescription Drug Plan offers different benefits — some basic, others more comprehensive.

• Basic Plans — must provide coverage at least as good as the standard drug benefit set by Medicare. You must pay specified deductibles, co-payments, coinsurance and other out-of-pocket expenses.
• Comprehensive Plans — coverage exceeds the standard drug benefit set by Medicare and may cover the deductibles and gaps in the standard plan. You pay lower beneficiary out-of-pocket expense.

No one single Medicare Part D Prescription Drug Plan will be able to meet every individual’s needs. There are likely to be several plans available in your area. Premiums, deductibles, co-payments, coinsurance and covered drugs will vary from plan to plan. As you evaluate plans offered, consider what you want from your Medicare drug benefit in terms of coverage, cost and convenience.

Just as they offer different coverage and cost-sharing amounts, Medicare Part D Prescription Drug Plans charge a different monthly premium for prescription coverage provided based on what a plan offers and where you reside. The amount of monthly Part D premium is not affected by your age, your health status or how many prescriptions you need. Also, each Medicare Prescription Drug Plan has lists of specific generic and brand-name drugs it covers (called “formularies”), as well as participating pharmacies you will need to use.

The Medicare Part D Prescription Drug Plans vary according to:

• Geographic location where you reside.
• Plan benefit design.
• Plan premium.
• Covered prescription drugs.
• Affiliated pharmacies.

Considerations

• Part D is a voluntary insurance program available to all Medicare beneficiaries. You can enroll when you first become eligible for Medicare or during Medicare’s annual election period, which occurs between November 15^th and December 31^st of each year.
• If you enroll in a Medicare Advantage Plan and you want drug coverage, check with your plan for the availability of drug coverage as you may not need a separate Medicare Prescription Drug Plan.
• If you participate in Original Medicare or a Medicare Advantage Private Fee-For-Service Plan, you may add prescription drug coverage by choosing a stand-alone Medicare Part D Prescription Drug Plan from one of a number of approved private companies operating as Medicare Part D providers in your location.
• Part D drug plans may change their cost and/or benefits from year to year. So you are allowed to change your choices of Medicare Prescription Drug Plans every year if you want or need to do so.
• If you are in a Medigap plan with no prescription drug coverage, you may choose the Medicare Part D Prescription Drug Plan that best fits your needs and no changes have to be made to your Medigap plan.
• Some states have their own programs to help residents with drug costs. Each state decides how its program will work with the new Medicare Part D Prescription Drug Program.
• If your income is low and you meet income/asset guidelines, you may get extra help with your Medicare Part D Prescription Drug Benefit. Those with the lowest incomes will pay no premiums or deductibles, will have small or no co-payments and will have no coverage gaps. Individuals with slightly higher incomes will have a reduced deductible and some will have a sliding scale premium and small coinsurance amount. For details contact the Social Security Administration at (800) 772-1213.
• To help you make an informed decision contact your Medigap or Medicare Advantage insurer or your State Health Insurance Assistance Program (SHIP).

You may also want to discuss the Medicare Prescription Drug Program with your pharmacist or physician.

Questions To Ask

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