Medicare Part D, or the Medicare drug insurance plan, covers prescription medicines for Americans over age 65 or for younger Americans with certain medical conditions, such as acute renal failure. It is one of four basic parts of Medicare. In most cases, it requires paying a premium to participate. Low-income individuals may qualify for a reduced premium. You can access your Medicare Part D benefits directly from Medicare, or you can enroll in a Medicare Advantage program, also known as Medicare Part C, that includes prescription drug benefits as part of its package.
Medicare Part D Drug Plans
Unlike Medicare parts A and B, which are uniform nationwide, the prescription drug plan costs and benefits can vary with your location. Basic, stand-alone prescription drug plans, also called PDPs, supplement Medicare Parts A and B. You also can use them with Medicare Private Fee for Service plans and Medicare Medical Savings Account Plans, or MSAs.
Medicare Advantage Plans
Medicare Advantage plans are managed care structures that provide coverage under Parts A and B, but also supplement that with a variety of other coverages, services and procedures not available under traditional Medicare. Some of these plans provide drug coverage as part of the plan or as an add-on. You can purchase a Medicare Advantage plan with an additional premium. You must be enrolled in Medicare Parts A and B to be eligible for Medicare Advantage. Medicare Advantage does not work if you also have a Medigap or Medicare supplement policy. So do not purchase both Medicare Advantage and Medigap coverage.
Formularies
Every Medicare drug plan is different. When you consider a prescription drug plan, either as a stand-alone plan or wrapped within a Medicare Advantage plan, look at the formulary, or list of covered drugs. Some companies have more restrictive formularies than others. Compare the formulary to the drugs you currently take or might be likely to take in the future.
Service Area
Because Medicare drug coverage companies offer service regionally, they frequently do not have contracts with drug stores and pharmacies outside of their coverage areas. When selecting a Medicare prescription drug plan, ensure that you can use the plan at the pharmacies in your area.
Costs
Compare the monthly premiums for competing plans. Premiums vary widely. You also should compare deductibles for various plans. This is the amount you must pay out of your pocket for prescription drug costs before Medicare benefits become payable. Last, compare any co-pay or co-insurance costs. These are the amounts you pay per prescription or the percentage of costs you must pay out of your own pocket.
Tags: Medicare Advantage, prescription drug, drug plan, Medicare Part, prescription drug plan, Advantage plan