Medicare Drug Plans Everything you need to know about drug prescription

This article will briefly guide you on what Medicare drug plans add to your health insurance coverage and how you can enroll in a suitable drug prescription program.

Medical drug prescription becomes essential after the age of 65. To avail of some health benefits, you might have registered for health insurance as an adult to cover the medical expenses. That is why you should look at your health insurance plan before enrolling in any Medicare drug plans. More often, your healthcare insurance plan offers to cover your medical prescription.

A Medicare drug plan covers any medication you pick up from the pharmacy. This plan will also cover any regular medicines like insulin. But it won’t cover any medication that a doctor may have prescribed during an in-hospital stay. You can carefully choose a drug prescription program from many options to add to your Medicare health program.

There are numerous benefits to the Medicare drug plans, including an auto-refill service that delivers your medication to your doorstep before it runs out. This refill service is based on the prescription allotted by a doctor, which states the number of medicines you may consume in a specific period. Based on that information, the network pharmacies can provide two to three months of supply through a mail-order program.

Several Medicare plans might cover your inpatient hospital charges, like Medicare part-A, including home healthcare facilities. At the same time, part B covers outpatient healthcare and medical supplies in the package. Since we are focused on the Medicare drug plans, part D of the Medicare program would cover a patient’s medication prescriptions.

What are Medicare Drug Plans?

Medicare offers a drug plan that provides drug prescriptions to everyone who avails of Medicare services. These are the drugs prescribed to you following your needs. Insurance companies run these drug prescription plans, and you can benefit yourself. In case if you don’t feel like availing of this prescription plan once you become eligible, nor do you have any other credible drug prescription plan at the time, you may have to apply to have to face an extra cost penalty. This penalty is only applicable if you have Medicare-approved prescription coverage later. The additional charges depend on the drug plan you avail. Each program offers specified drugs.

How can you avail of Medicare Drug Plans?

To avail of Medicare health coverage, you must be a U.S. citizen or reside in the United States under lawful means. Two methods can benefit your medical prescription, which is stated below:

  • Medicare Drug Plans You can add the prescription part D with the other Medicare insurances, including Part-A and Part-B Medicare. By using this service, you will be including drug coverage service to your several Medicare programs like Private Fee for Service Plans, Medicare Savings Account plans, and Medicare Cost Plans.
  • Medicare Advantage Plan You can also choose to avail Medicare health plan (Part-C) with drug coverage to avail of the drug prescription service. With these plans, you can benefit from Part-A and Part-B of Medicare.

Before deciding on availing of the Medicare Prescription coverage plan, consider your choices with the other plans. Bear in mind that drug coverage may affect your Medicare Advantage plan. Under certain circumstances, Medicare may not offer drug coverage. Such conditions may include acquiring a Medical Savings Account Plan. However, you can join Medicare drug plans without losing your current coverage if your health insurance is among the following programs:

  • Medical Savings Account plan
  • Cost plan
  • Private Fee-For-Service plan
  • Specified Employer-sponsored Medicare health plans

What is Drug Formulary?

Drug Formulary represents a list of prescription medicines representing a particular brand name or generic drugs provided by your healthcare plan. Since Medicare Part-D is a drug plan, the most important drug formulary should be considered. Every provider must include a wide range of drugs in their program, requiring at least two different medications for the same category. The drug formulary should be compared based on your prescription that which plan covers your required drugs.

Tips for choosing Medicare Drug Plans

Suppose you’re confused about choosing the best drug plan program that suits your needs. Follow these tips to set your priorities straight:

  • If you take any specific drugs, try to find a plan that includes your prescribed medication. Your prescription should be based on the formulary offered by the drug plan. You can compare the list of the drugs provided by the program based on medication costs to make an economical choice.
  • If you want to save more on high prescription drugs, look at the coverage gap. The coverage gap is the period in which you tend to pay higher costs for the drugs until they consider you qualified for the catastrophic coverage. Then go on checking for those plans which can cover your medications in the gap. The coverage gap begins when your program has stated a specific amount for the drugs you have consumed in that year.
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  • To keep your drug expenses balanced throughout the year, try to search for drug plans with low deductibles. A deductible is an amount you have to pay before availing of a healthcare plan like Medicare original or Medicare Advantage plan.
  • Try to avoid plans that include additional charges over the coverage gap.
  • Medicare drug plans with tiers can be beneficial and economical if you stick to a specified course of medication. Several plans charge no or low costs over drugs in a group with different prices.
  • Want a peace of mind without worrying about the costs? Look for Medicare drug plans with low premium costs. Premium covers most of the drugs you may find in almost every healthcare plan.
  • If you want to earn extra benefits at low costs, try availing of the Medicare Advantage Plan (Part-C) with drug coverage. It is like an all-in-one package for your healthcare and prescription services.

Factors that can vary costs of drug coverage plans

The amount of price you might have to pay to cover the actual costs may vary depending on:

  • Whether your prescriptions are available on the formulary list of your chosen plan.
  • Whether the drugs you require are included in the tier of chosen plan or not.
  • Which drugs benefit phase you correspond to. It may include meeting the deductible levels or if you’re under the catastrophic coverage phase.
  • The type of pharmacy you prefer also imposes an impact. If you choose a specific pharmacy, they might charge you less.
  • Whether you avail of additional help by the charges, you pay for Medicare drug coverage.

Medicare Part D enrollment

The prescription drug coverage of Medicare (Part-D) does not come with the Original Medicare plan. You can avail of the benefits of Part-D by enrolling for a separate Medicare Prescription Drug Plan or through the combined Medicare Advantage Drug Plan. The Advantage Drug plan includes benefits of both Medicare Part-A and Part-B.

Who is eligible to apply for Medicare Drug Plans?

Under the specific terms and conditions, one can apply for the Medicare prescription plan. You can choose to join or switch the Medicare drug plan once you reach the particular age of 65. You become eligible to sign up for seven months, three months before legally reaching the age of 65.

This initial enrollment period includes the month you turn 65. Your coverage starts from the day of your birth month. If you enroll during the last moments of your Initial Enrollment Period, you might face a delay in initiating your coverage. Here is a more detailed breakdown of how the coverage plan enrollment works:

  • You can join a Medicare Drug Plan if you get Part B for the first time within the General Enrollment Period. This enrollment window states that you can participate from April to June, and your coverage will start on 1st July.
  • If you apply under open enrollment between 15th October and 7th December, the coverage will begin on 1st January by the following year.
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  • You can make changes to your insurance plans during the Special Enrollment Periods, also known as SEPs. These changes are only allowed under certain circumstances like moving residential locations or losing health care insurance.

How to join a Medicare Drug Plan?

You can join the Medicare Drug Plan by applying within the initial enrollment period. Following are the methods to join the plan:

  • Register and enroll yourself on the Medicare Plan Finder. Or visit the Medicare website.
  • You can fill in the paper enrollment form and submit a request to avail of the plan.
  • Reach Medicare through their helpline by calling at 1-800-MEDICARE.

Is it necessary to join Medicare Drug Plans?

It is up to you whether or not you want to avail any Medicare Drug Plans. Although if you don’t apply during your initial enrollment two months after the required age, you’ll have to opt for late registration. The penalty could be served to the individual who avails of the Medicare Advantage prescription drug plan in the future.

Late Enrollment Penalty

In case of late enrollment, you may have to pay a certain amount added to your Medicare drug coverage of Part D. This penalty is served if you miss the chance to register during the initial enrollment period. A time period of 63 or more days in a row is considered before the penalty if you don’t have any creditable drug coverage insurance during this time.

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Your insurance plan will let you know about any due penalties once you apply for Medicare drug coverage. The charges for late enrollment depend on the length of period you spent before your late sign-up. For now, the late enrollment penalty charges are multiplied by 1% (33.37 USD) by the full months you spent without availing of any credible drug prescription coverage. A round-off amount of 0.10 USD is included in your monthly premium. These charges are based on the National Base Beneficiary Premium, increasing every year.

How to avoid the late enrollment penalty of Medicare Part D?

  • Make sure to enroll for a Medicare drug plan once you reach the age of 65, even if you don’t take any medication. During the initial period, you don’t get to face any penalties. At this time, you might be eligible to avail of premium offers with no or low additional charges.
  • Keep Medicare posted about your previous prescription plan history. Updating Medicare about any credible health coverage you have availed in the past can save you from penalty charges.
  • If your current healthcare coverage is not reasonable, your non-Medicare drug plan should update about the credibility of coverage. Try not to spend two months after 65 without any creditable drug coverage plan. Otherwise, you may have to pay penalty charges when you sign up later.

Best-rated Medicare Part D plans

The Medicare drug plans, more commonly known as Part-D plans, are stand-alone insurance policies available from private insurance companies. One might wonder why this insurance policy is necessary when there are already several other plans. That’s because some of the medicines are not covered by Medicare Part-A and Part-B. These plans mainly cover your hospital and medical insurance.

Below is a list of some reputed insurance providers who give the best Medicare drug plans based on their ratings and average costs:

Rank Medicare Drug Plan Provider Average cost per Month Ratings
1 Kaiser Permanente 33 USD 4.9/5
2 United Healthcare 52 USD 3.9/5
3 BlueCross BlueShield 69 USD 3.9/5
4 Humana 38 USD 3.8/5
5 CVS Health 35 USD 3.7/5

 

Among these top-rated insurance providers, United Healthcare and Humana are the most popular drug insurance plan providers. US citizens trust and avail these insurance providers across the country due to their credible service and affiliation with vast pharmacy networks.

Be wise to choose a plan based on the average costs. Although the out-of-the-pocket price for Medicare part D is approximately 33 USD for 2022. However, this figure may vary based on several factors like low or high-income adjustments and additional premiums.

Medicare Plan Finder

Medicare Plan Finder is a user-friendly tool to find the best insurance plan suitable for your health coverage, hospital coverage, and drug coverage. The Medicare Plan Finder provides all the information about average costs and benefits you can avail of from several plans on the website. With the new improvised interface, the Medicare Plan Finder makes it possible to compare coverage options and shop for plans.

Features of the Medicare Plan Finder

Medicare plan finder has made it easier for US citizens to form Drug Plans and Medicare Advantage plans with their platform. Having a simple prompt, clean design, and enhanced number of plans, you can avail the following features to compare coverage options:

Continuing without Registered Account

If you want to access the Medicare Plan Finder without a registered account, the website will ask you some basic questions to give you the best Medicare Part D plan.

  • You can enter your zip code and the preferred plan you’re looking for.
  • Next, you have to add drugs by searching in the name or choosing from the log provided on the website database.
  • Once you make a drug list, enter your complete address and preferred pharmacy.
  • The last and final step is to select the plan type and filter the results by sorting price and benefits. The website will generate plans with a formulary including your prescribed drugs.

Continuing with a Registered Account

Reach the online service of Medicare Plan Finder and log in using your credentials. Your log-in credentials can help generate personalized results related to your area or zip code. With your Medicare Plan Account, you can:

  • Create and Access your list of drugs.
  • Compare benefits of plans with your current insurance program.
  • Check prices of any premium packages and drug costs.

With the Medicare Plan Finder, you can also learn about various coverage options like Medicare Advantage Plan, Original Medicare, Medicare Prescription Drugs Plans, and Medicare Supplement Insurance. You can fetch the data related to the plans’ costs and benefits through the Plan Finder.

The improved compare feature allows comparing three different Medicare Drug Plans or Medicare Advantage Plans side-by-side. You can generate a personalized drug list to get drug coverage recommendations using your prescription data. You can type in the name of a specific drug, and the Plan Finder will let you know about its lower-cost alternatives.

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Conclusion

Applying for health insurance earns you many benefits to assist you in living a happier and healthier lifestyle. You may get health coverage and hospital coverage advantages with various Medicare coverage plans. But drug prescription coverage is overlooked while choosing an insurance plan. The cost-benefit on prices of drugs is also a significant advantage of availing Medicare prescription programs. If the costs for medicines are increased, you can approach your doctor to suggest better alternatives for some reason.

With the Medicare Drug Plans, you can assist your hospital coverage benefits with proper prescription assistance. So once you choose the right plan, you don’t have to worry about the shortage of supply, and you’ll complete the dosage without any delay. Therefore, be wise to avail this opportunity once you become eligible to apply for the plan.

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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