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Does Medicare Have Coverage for Prescription drugs?
Prescription drugs are covered under Part D of Medicare. People who have Medicare Part A or Medicare Part B are eligible for Medicare prescription drug coverage. They can enroll in any of the Part D plans that serve the area where they live.
The Annual Election Period (or Open Enrollment Period) for Part D is from October 15 to December 7. During this time period, anyone with Medicare can enroll in a plan or change from one plan to another. There are some important things to keep in mind when it comes to prescription drug coverage:
- It is very complex, can be confusing and is changing on a regular basis. You will have to make decisions to get the plan that is right for you and covers the drugs you need.
- You can get help making decisions through local resources and/or your Medicare Advantage Plan (such as an HMO or PPO).
- You do not have to purchase Part D coverage. That decision will not affect the other coverage you have. It is important to note that you should enroll in a prescription drug plan when you are eligible. If you choose to enroll later, you will have to pay a higher premium for a Part D plan, unless you can show Medicare that you had drug coverage at least as good as theirs during the time you were not enrolled in Part D. This is known as "creditable coverage."
How can I delay reaching the Coverage Gap?
There are a number of things you can do to help reduce your drug costs, they include:
- Switch to lower-cost drugs: Talk to your doctor about using generic and/or over-the-counter (OTC) drugs. Many work as well as the higher cost prescriptions. It can help you save hundreds of dollars a year and can be just enough to keep you out of the Coverage Gap.
- Take advantage of mail-order programs: They can save you many dollars a year on medication you take long-term for ongoing conditions (90 days or longer).
- Always use your Medicare drug plan card. When you use your card, you get discounted rates on the drugs you buy and any money spent on drugs is automatically counted automatically toward your deductible.
- Look for programs that offer assistance: The National Patient Advocate Foundation or the National Organization for Rare Disorders may have programs that can help with your drug costs. Comprehensive information on federal, state and private assistance programs in your area is available at www.benefitscheckup.org.
Can I get extra help if I have a low income?
If you have limited income and resources, you may have been automatically enrolled in a program (this may vary state to state). If you have not been automatically enrolled in a program, you may still qualify for Extra Help from Medicare. If you qualify, you will get help paying for your Medicare drug plan's monthly premium, deductible, and copayments. The amount of Extra Help you get is based on your income and resources.
You will automatically qualify for help if you meet one of the following criteria:
- You get full coverage from a state Medicaid program.
- You get help from Medicaid paying your Medicare Part B premiums (a Medicare savings program).
- You get Supplemental Security Income (SSI) benefits.
If you qualify for Extra Help but don't join a Medicare prescription drug plan yourself, Medicare will enroll you in a plan so that you get help paying for your prescription drugs (Medicare will send you a letter letting you know when your coverage begins). However, if you have certain retiree drug coverage from a former employer or union, Medicare will not automatically enroll you in a plan. For more information, contact your local Social Security office, or call 1 800 MEDICARE (1-800-633-4228). TTY users should call 1-877-486-2048.
What Does Part D Cost?
Exact costs are different for each plan, depending on your coverage. Your actual drug plan costs will vary depending on the prescriptions you use, the plan you choose, whether you go to a pharmacy in your plan's network, whether your drugs are on your plan's formulary (drug list), and whether you get Extra Help paying your Part D costs. Most drug plans charge a monthly premium that varies by plan. You pay this in addition to the Part B premium. If you belong to a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium you pay to your plan may include an amount for prescription drug coverage.
In addition to your monthly premium your costs for Part D coverage include:
- Annual Deductible - This is the amount you pay for your prescriptions before your plan starts to share in the costs. Deductibles vary by plans. Some plans do not have deductibles.
- Copayment / Coinsurance - This is the amount you pay out of pocket each time you buy a prescription. These costs can vary from plan to plan, and also vary depending on drug tiers (drugs in a higher tier tend to cost more than those in a lower tier) and which stage of the benefit you are in at the time of purchase.