How do I choose a Medicare drug plan?

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Medicare Part D, offered separately from Original Medicare Part A and Part B, is Medicare’s prescription drug plan. These plans are standardized by Medicare but administered by private health insurance companies. All plans look similar in structure, with differences in the drugs they cover and in the copayments and premiums they charge. There might be many prescription drug plans available in your area, in which case it is important to choose based on your prescription and financial needs.

What Prescriptions Are Covered?

If you take specific drugs, you will need to find a Part D plan that covers your drug. Each plan chooses which drugs to cover, although at least two drugs in the most commonly prescribed categories are covered in each plan. Effectively all drugs are covered in these categories: anticancer, anticonvulsants, antidepressants, antipsychotics, antiretrovirals, and immunosuppressants.

To find out if your drug is covered, find the plan’s drug list, known as its formulary. Drugs will be listed alphabetically by their generic or brand name along with the tier of drug they fall under. These tiers are how insurance companies decide how much you owe at the pharmacy. Generic, preferred drugs are least expensive, followed by generic drugs, brand name drugs, non-preferred drugs, and specialty drugs in tiers 1 through 5. Tier 1 indicates the lowest copayment and tier 5 means you will owe the highest copayment, which is usually a percentage of the retail cost for specialty medications (drugs that require special handling or administration).

Coverage Gap

One of the troubles with prescription drug costs is the coverage gap, which you may fall into if you have spent more than your out-of-pocket maximum. During the time you are in the coverage gap, your cost sharing will be higher until you have paid enough to reach the threshold for catastrophic coverage. Some plans offer coverage in the coverage gap. If you are concerned about high prescription drug costs, you can seek out a plan with this coverage.

Costs will vary between plans, but there are plans with low monthly premiums available as well as plans with low deductibles. Depending on your prescription usage, these options may help you save or provide a safeguard for those who have few prescription costs. If many of your prescriptions are generic, look for a plan that has generic prescriptions in low tiers that charge you very little in copayments.

Medicare Advantage

An alternative to Part D for prescription drug coverage is choosing a Medicare Advantage plan, which covers your Part A and Part B benefits with additional coverage for prescription drugs mirroring that in Part D plans. If you want to switch from Original Medicare to a Medicare Advantage plan, you need to be enrolled in Part A and Part B and live within the plan’s service area. Many beneficiaries wanting drug coverage choose to either enroll in Medicare Advantage or add Part D to their Original Medicare.
A Part D prescription drug plan or a Medicare Advantage plan with prescription drug coverage can be beneficial to those looking for that extra coverage. For more information about how each plan could benefit you, give Bobby Brock Insurance a call today.

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Justin Brock

President & CEO of Bobby Brock Insurance