Medicare is a type of health insurance that the federal government offers to people who are 65 years of age or older. It is also provided to certain younger people who suffer from disabilities and some people who suffer from fatal diseases. There are different types of Medicare coverage as well, including Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D.
- Medicare Part A (hospital insurance) is the type of Medicare that all people get, and it covers basic services like in-patient hospital stays.
- Medicare Part B (medical insurance) is essentially Medicare health insurance that individuals have to pay a monthly premium to have.
- Medicare Part C is the type of Medicare that is covered by private companies. This means that the private companies pay for their clients’ Medicare Part A and B coverages.
- Medicare Part D is the type of coverage that applies specifically to paying for people’s prescription medications.
Medicare Part D prescription drug coverage
Medicare Part D prescription drug coverage is a type of coverage offered to everyone with Medicare. Therefore, in order for an individual to be eligible for Medicare Part D coverage, he or she must first have basic Medicare coverage.
When people enroll in Medicare, they can opt for the prescription drug coverage plans. If they choose not to do so initially, they could end up having to pay more later on, if they later decide that they want the coverage. They might even have to pay a late payment penalty.
How to get Medicare Part D prescription drug coverage
As with other parts of Individuals who want to get Medicare Part D prescription drug coverage must join a plan that is run by a private company or a Medicare-approved insurance company. There are different types of Medicare Part D prescription drug coverage plans. The cost of the each plan depends upon the type of the plan and the drugs that are covered under the plan. Generally, though, there are two types of Medicare Part D coverage plans.
- Medicare prescription drug plans (PDPs) — These are the types of plans simply add prescription drug coverage to Original Medicare. They can also add prescription drug coverage to some Medicare Medical Savings Accounts (MSA) plans, some Medicare Private Fee-for-Service (PFFS) plans and some Medicare Cost plans.
- Medicare Advantage plans — Individuals who have a Medicare Advantage (MA) plan, which is simply a Medicare Part C plan, can get their hospital insurance, medical insurance and prescription drug coverage through their plans. Not all Medicare Advantage plans come with this coverage. In order to get this type of coverage, individuals must have both Medicare Part A and Part B coverages through their providers.
Joining a Medicare drug plan
People who want to join a Medicare drug plan can only do so during the appropriate times. There are specific times when people are allowed to sign up for Medicare drug plans or make changes to existing coverage that they already have. When people first enroll in Medicare, they are given the option to enroll in Medicare Part D coverage. However, the time frame that they are allotted to enroll in the coverage depends upon their individual circumstances.
- People who just turned 65 years old and are newly eligible for Medicare may sign up for a Medicare Part D coverage plan during their seven-month enrollment period. This begins three months before the month that they turn 65 and ends three months after the month that they turn 65.
- People under 65 who are eligible for Medicare because they are disabled may sign up for a Medicare Part D or Medicare Part C plan during the seven-month period. This begins three months before their 25th month of receiving their Social Security or Railroad Retirement Board (RRB) benefits and ends three months after their 25th month of receiving their benefits.
- People who don’t have Medicare Part A coverage and enrolled in Medicare Part B during the general enrollment period can sign up for a prescription drug coverage plan.
- People who have Medicare Part A and signed up for Medicare Part B during the general enrollment period may sign up for a Medicare Advantage plan (Part C coverage).
People who already have a Medicare prescription drug coverage plan may make changes to their plans from October 15 through December 7. Some of the actions that people can do during this time period include the following:
- Drop their Medicare prescription drug coverage completely
- Switch from one Medicare prescription drug plan to another
- Join a Medicare prescription drug plan
- Switch from Original Medicare to a Medicare Advantage Plan or vice versa
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
- Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to one that does and vice versa
Types of Medicare health plans
Medicare health plans that are offered under Medicare Part C are those that are offered by private companies that have partnered with Medicare to provide individuals with their coverage. The following are the types of Medicare health plans that individuals may choose from:
- Medicare Advantage plans
- Medicare Medical Savings Account (MSA) plans
- Medicare Cost plans
- Demonstrations and pilot programs
- Programs of All-Inclusive Care for the Elderly (PACE)
- Medication therapy management programs for complex health needs
What drugs Medicare prescription drug plans cover
The drugs that are covered under Medicare prescription drug plans depend on the plan’s formulary, otherwise known as the list of drugs that the plan covers. Most Medicare prescription drug plans place drugs into different tiers on their formularies. The tier that the drug is in affects the cost of the drug.
Generally, drugs in higher tiers cost more than drugs in lower tiers. In some cases, individuals’ physicians may believe that they need a drug that is on a higher tier. Should that occur, people could ask their prescription drug plan providers for exceptions to get lower copayments on their prescriptions.
Medicare Plan Finder
The types of prescriptions drug plans that people can get vary depending upon their location, as well as their individual Medicare information. The Medicare website offers individuals a Plan Finder search that allows them to search for and compare various prescription drug plans offered in their areas.
There is even a customizable search that allows users to input their Medicare card numbers, dates of birth, effective Medicare Part A coverage dates and locations to provide them with more accurate cost estimates of what a Medicare Part D prescription coverage plan would cost them. The costs of such plans vary, based upon individual information, as well as location and coverage type.
Getting prescriptions is a common part of going to the doctor. For people who have monthly, recurring prescriptions that they must have, it might be beneficial for them to invest in a Medicare Part D prescription drug coverage plan.
Even individuals who previously opted out of Medicare Part D coverage when they initially enrolled in Medicare, but who now realize that they need it, can end up enrolling in Medicare Part D prescription drug coverage plan. They can enroll during the general enrollment period that is offered to all Medicare holders every year.