Prescription Drug Plans

If you have a Medicare Part D Prescription Drug Plan and a Medicare Supplement Plan that covers drugs, you need to tell your Medicare supplement insurance provider to remove the drug coverage from your policy.

You cannot have both Medicare Part D and Medicare Supplement plan drug coverage at the same time.

Attention: At times, Medicare Part D coverage is more beneficial than the Medicare Supplement plan drug coverage, so compare both carefully.… Read more

How do you know if the drugs you currently take will be covered by a Medicare Part D Plan?

All Part D plans must meet formulary requirements set by Medicare. The formulary includes brand name as well as generic drugs. To establish the formulary, each prescription drug plan must use a Pharmacy and Therapeutic Committee, including a team of doctors and pharmacists. The formulary assures that you have access to these drugs, although it might not necessarily include all available drugs.

Each Medicare Part D plan’s formulary can usually be found on the insurance provider’s web site, or by contacting their customer service. You can also get information by visiting Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227).

Drugs that are excluded from Part D by Medicare are:

• Drugs for anorexia, weight loss, or weight gain
• Fertility drugs
• Drugs for cosmetic purposes
• Drugs for hair growth
• Drugs for the symptomatic relief of cough and colds
• Prescription vitamins and mineral products (except prenatal vitamins and fluoride preparations)
• Non-prescription drugs
• Barbiturates (sleeping pills)
• Benzodiazepines (central nervous system depressants)
• Inpatient drugs
• Drugs purchased outside the US

Also, a drug cannot be covered under your Medicare Part D plan if the payment for that drug is available under Parts A or B of Medicare, for example drugs you receive in a hospital or at a physician’s office.… Read more

Seniors with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.

Here is how Medicare Part D coverage works:

• You pay out-of-pocket for monthly Part D premiums all year
• You pay 100% of your drug costs until you reach the deductible
• After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches the current limit for the year
• Once you reach this limit, you have hit the coverage gap referred to as the ‘donut hole‘, and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit
• After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs

There are some Medicare Part D plans that offer coverage in the donut hole, but these plans may charge a higher monthly premium. There are also some Part D plans that offer fixed co-pays (e.g. $10 or $20) for prescription drugs instead of the deductible and 25% cost-sharing that was described above.… Read more

Medicare Part D: What is it?

Medicare’s prescription drug program was created as a result of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Although the Act was written into law in 2003, Medicare eligible individuals did not start enrollment into these plans until January 1, 2006. This plan is commonly referred as PDP (Prescription Drug Plan) or simply Part D.

Part D is available to everyone who has Medicare regardless of income or health history. Private insurance companies provide the coverage. The enrollees select a plan from those available in their geographic region and pay the insurer a monthly premium for the coverage. Even though enrollment is voluntary there is a penalty for late enrollment which will be discussed a bit later in this article.

You can elect to enroll in a Medicare Prescription Drug plan in one of two ways:

(1) Stand along prescription drug plans (PDP); or

(2) Medicare Advantage Prescription plans (MA-PD).

The first type of plan covers prescription drug benefits only. These plans were designed for people who choose to stay with traditional fee for service Medicare and need the prescription drug coverage along with a Medicare supplement to round out their medical coverage.… Read more