As a valued member of the 65 plus club, it's important to understand Medicare's prescription drug coverage options. Medicare offers prescription drug coverage to all Medicare beneficiaries. If you choose not to join a Medicare Prescription Drug Plan when you are first eligible and do not have other credible prescription drug coverage or Extra Help, you may incur a late enrollment penalty. To access Medicare drug coverage, you must enroll in a plan administered by an insurance company or another private company approved by Medicare. The cost and drugs covered can vary between plans.
There are two ways to obtain prescription drug coverage:
1. Medicare Prescription Drug Plan (Part D): These plans, also known as PDPs, add drug coverage to Original Medicare, certain Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plan (Part C) or other Medicare health plans: These plans, such as HMOs or PPOs, offer Medicare Part A and Part B coverage along with prescription drug coverage (Part D). Plans with prescription drug coverage are often referred to as "MA-PDs." To join a Medicare Advantage Plan, you must already have Medicare Part A and Part B.
It's important to note that each Medicare Prescription Drug Plan has its own formulary, which is a list of covered drugs. These drug plans typically categorize drugs into different tiers, each with its own associated cost. Drugs in lower tiers generally have lower costs compared to drugs in higher tiers. However, if your prescribed medication falls into a higher tier and your healthcare provider believes it's necessary, you or your prescriber can request an exception from your plan to obtain a lower copayment for that specific drug instead of a similar drug in a lower tier.
Understanding your prescription drug coverage options under Medicare is crucial to ensure you have access to the medications you need while minimizing your out-of-pocket expenses. Take the time to compare plans, review formularies, and consider your specific medication needs when selecting the most suitable Medicare prescription drug coverage for you.