Part D plans are prescription drug plans provided by private health insurance carriers. Original Medicare does not cover prescription drugs. A drug plan can be combined with a Medicare Advantage plan or can be a standalone drug plan that you enroll in separately from Original Medicare with or without a Medicare Supplement.
You can enroll or drop a Medicare Part D plan or make a change to your plan during a period known as the Medicare Annual Enrollment Period (AEP). AEP takes place each year from October 15th through December 7th. Any changes you make will become effective January 1st of the following year. Part D plan options available to you can be found on www.medicare.gov along with the CMS star ratings for each drug plan, which indicate the quality rating of each plan.
If you don’t enroll in Part D coverage when you are first eligible for Medicare, either as part of a Medicare Advantage plan or through a standalone plan, or if you are without creditable prescription drug coverage (such as a plan offered by your employer) for 63 days or more, you may have to pay a penalty. Once you do join a Part D plan, this penalty is assessed and will continue every month for the life of your coverage.
This is why it’s especially important to review your coverage needs and determine if a Part D prescription drug plan is right for you before you even become eligible to enroll. This will help you make better evaluations of your needs and the coverage that can be most useful to you. However, even if you may not need a Part D plan right now, it could still be helpful to enroll in one as soon as you become eligible. Doing so will provide you with prescription drug coverage in the event of an emergency.
Once you have identified the Part D plans available to you, you’ll want to compare your options to determine which plan provides you with the most value. If you have a preferred pharmacy, check to see if it is in-network with the plan you are considering. Many plans will not cover a prescription at a non-participating pharmacy. You can also confirm if there are mail order options for drugs you use regularly. Some plans require you to use mail order while others provide you with a discount for doing so, such as providing a three-month drug supply for the price of two.
Next, review your list of drugs that you take regularly. For each Part D plan you are considering, review their formulary to determine the coverage level for your medications. A formulary is a detailed list of prescription medications that indicates the health plan’s coverage level for each drug. Some plans use tiers to indicate the cost-share you will need to pay. Be sure to find out whether or not a deductible applies to your Part D coverage. If it does, you’ll need to pay out-of-pocket before your plan covers the cost of your prescriptions. Be sure to confirm the coverage level after the deductible has been met. Many plans have a copay or coinsurance that you will need to pay each time you fill a prescription.
Don’t forget to review any kind of authorizations or requirements for your prescriptions. For example, you may be required to try the generic version of a medication before the plan will pay for the brand-name medication, or you may be required to obtain authorization from your doctor before the plan will cover the cost. Another thing to look out for is any limits on the number of refills that will be covered.
Formularies can change each year. Just because a drug was covered by your plan last year doesn’t mean that it will be covered this year. Ensure that you review your medications, and your Part D plan each year to confirm coverage and make any changes to your enrollment if needed.
After you have determined the coverage each Part D plan will provide, you can look to see which plan will be the best for you. Add the monthly costs of any drugs along with the monthly premium to determine the total cost of coverage.
At Medicare Peace of Mind, we understand how important it is that you find the coverage that works for you. That’s why we are dedicated to helping you prepare and compare all your plan options. Any questions or concerns you may have regarding your Part D or other Medicare plan options can also be answered by us!
You don’t have to go through this process alone. If you’re looking for answers, we’re here for you and can help you review your Part D coverage options. Give us a call at 970-233-0633 to learn more.