Medicare’s prescription drug program is called Medicare Part D. These Prescription Drug Plans are offered separately from Original Medicare Part A and Part B. You can purchase a Part D plan from a private health insurance company. These plans are standardized to include the coverage you need.
Medicare Prescription Drug plans cover essentially all of the prescription drugs in the most commonly prescribed categories. These six areas with nearly all drugs accounted for include anticancer, anticonvulsant, antidepressant, antipsychotic, antiretroviral, and immunosuppressant drugs.
Prescription drug programs are allowed to make changes to the drugs they cover during the year. If any of the changes they make affects a drug you are currently taking, they will give you at least 30 days of advance notice before the change goes into effect or provide you with a month’s supply of prescription at the previous rate.
If you are prescribed a drug that is not covered by your plan and cannot be adequately substituted by a drug that is covered by your plan, you and your prescriber can request an exception. The same can be done if you are prescribed a drug at a quantity higher than the limit covered by your prescription drug program.
The main benefit of prescription drug coverage is reduced costs at the pharmacy. When you fill a prescription, you will pay a set copayment and your insurance company will cover the rest. These copayments are based on whether your prescription is generic, brand-name or specialty and whether or not the drug is preferred by your plan. Generic, preferred prescription drugs will have the lowest copayment and specialty drugs requiring special handling or administration will have the highest copayment.
Monthly premiums for Part D are dependent on the individual plan. However, if you claim over a certain amount of income on your tax return, you will owe Medicare a Part D Income Related Monthly Adjustment Amount (IRMAA). You pay this charge directly to Medicare.
Alternatively, you could sign up for a Medicare Advantage Prescription Drug plan. These plans are a combination package with the coverage of Medicare Part A, Part B and Part D all in one. Under a Medicare Advantage prescription drug program, you have the same coverage as under a standalone Part D plan.
The most important part of finding a prescription drug plan is making sure your prescriptions are covered. For help in finding the best prescription drug program in your area, reach out to Jones Insurance Group.