As we age, we tend to incur more medical expenses, with prescription drugs being one of the most common. If you are nearing 65, you may be wondering how Medicare will affect your current prescription costs. The type of Medicare plan you choose will determine your options for obtaining prescription drug coverage.
If you opt for Original Medicare, which comprises Part A for hospital coverage and Part B for medical coverage, you can choose to add prescription drug coverage through Part D. This plan is commonly known as the Medicare Prescription Drug Plan, and it aims to complement Parts A and B. On the other hand, if you select Medicare Advantage, Part D prescription drug coverage is usually included in the plan benefits.
When to Enroll in part D
To be eligible for a Medicare Prescription Drug Plan, you must meet the same criteria as for all other Medicare plans. This includes being a US citizen or a legal resident for the last five years and at least 65 years old. You must also have coverage through Part A and/or Part B, or choose an Advantage plan that includes Part D benefits.
Enrollment in Part D plans, like all Medicare coverage, is subject to an initial enrollment period. It is essential to enroll proactively during this period as delaying enrollment could result in late penalties. While many individuals are automatically enrolled in Original Medicare, enrollment in Part D benefits requires proactive action.
You can also change your Part D coverage during Medicare’s Annual Election Period from October 15 to December 7.
If your private health insurance plan is contracted by Medicare, it may also offer prescription drug coverage. It is crucial to understand your current benefits before opting for Part D benefits.
What Prescriptions Are Covered?
If you currently take prescription drugs, it’s essential that you review the various schedules of costs, called formularies, to see if your specific medications are covered under the Part D plan you are selecting. Not all plans cover all drugs, so selecting the one that closely matches what you are currently taking can significantly reduce your out-of-pocket costs.
It’s possible for our prescription drug needs to change, necessitating a change in our Part D coverage. During the Annual Election Period, take the time to consider whether your current plan is the most cost-effective for you. Formulary costs may change at any time, but your Medicare plan will notify you if that happens.
Prescription Drug Plan Part D
When individuals become eligible for Medicare, they have several health coverage options to consider. While some choose Original Medicare, consisting of Part A hospital coverage and Part B medical care, it may not provide enough benefits.
Another option, Medicare Advantage, combines both plans and frequently includes a Part D prescription drug plan along with other resources for dental and vision care. Whether you select Original Medicare or an Advantage plan, it is wise to consider adding Medicare Part D to your benefits package, as it assists with prescription drugs.
What Part D Pays For
Pharmaceutical pricing can often reach unreasonable costs and it can be difficult for individuals on a fixed income to afford the medication they need. Depending on the prescriptions you currently take, you may be able to save money through the use of Part D benefits. Various plans will cover different prescriptions, so it’s imperative that you review the formularies of each before enrolling. This will ensure that the bulk of your medications are covered to their fullest extent.
Remember, as with all Medicare plans, Part D does not pay 100% toward your prescription costs. Instead, it is designed to offset the charges and allow individuals to receive their medications at a reduced cost. Prices for various drugs can change at any given time, but your plan’s formulary will reflect that.
Prescription Coverage Stipulations
If you’re covered under Medicare Parts A and/or B, you have the option to add Part D coverage for prescription drugs. Note that while Original Medicare often automatically enrolls individuals at age 65, Part D benefits require additional enrollment steps. Alternatively, Medicare Advantage recipients can select a plan that includes medication benefits, all under one plan.
It’s important to check if your current health insurance plan through an employer or spouse already includes prescription medication benefits before opting for Part D coverage.
Be aware that there’s a limited time to enroll in Part D benefits as a late enrollment penalty may apply if you opt out and later decide to enroll. Medicare offers an Annual Election Period where you can make changes to your coverage, so your initial Part D selection isn’t necessarily set in stone.
Take the time to evaluate whether Part D benefits align with your needs. For some, paying extra for monthly premiums may not make sense due to limited medication use. Meanwhile, others may benefit from the additional coverage if they have expensive prescriptions.
Our team is made up of compassionate, friendly individuals who understand the unique needs of older adults. We take the time to listen to your concerns and provide personalized solutions that work for you. We provide additional and detailed information on Medicare Health Plans and a no-cost plan comparison to determine if you qualify for additional benefits.