For many seniors, the No. 1 health insurance concern is prescriptions drugs. Fortunately, there are numerous options for seniors who need help accessing and affording prescription drug plans.
Prescription drugs under Medicare
Coverage for prescription drugs, both name brand and generic, is handled by Medicare Part D. You can add Part D to:
- Original Medicare
- Some Medicare Private Fee-for-Service Plans
- Some Medicare Cost Plans
- Medicare Medical Savings Account Plans
If you have a Medicare Advantage Plan, chances are you already have prescription drug coverage. These plans typically contain parts A (hospital insurance), B (medical insurance) and D.
What drugs are covered?
There are various Medicare prescription drug plans, and each one covers separate drugs.
In most cases, a plan will classify different drugs as part of a specific tier. Drugs in lower tiers typically cost less than those in higher tiers. However, if your health care provider believes you need a drug in a higher tier instead of one in a lower tier, you have the option of appealing to your plan for a lower copayment.
Medicare prescription drug plans can change throughout the year. If a change does occur that concerns a drug you're taking, your plan must provide written notice at least 60 days before any changes take place. Additionally, when you go to refill your prescription, your plan must also provide written notice of the change and supply you with 60 days' worth of the drug under the same plan rules as before the change.
How much does coverage cost?
While Medicare prescription drug plans can certainly help seniors afford the medication they need, coverage does come with costs of its own.
Among the expenses are:
- Premiums: This is a monthly fee that varies depending on your plan.
- Yearly deductibles: This is an annual cost that also varies depending on the type of plan you have.
- Copayments or coinsurance: Besides routine premiums and deductibles, you will also need to provide either a copayment or coinsurance payment for each of your prescriptions. These costs will be determined by what tier your drugs are in.
- Coverage gap costs: Once your plan has reached its limit for how much it will pay toward prescription drugs, you enter the coverage gap. This limit will depend on how long you've been using your prescription drug plan. Additionally, the out-of-pocket expenses will only be for a specific percentage of the drug.
- Late enrollment penalties: If there's a period of 63 days or more in a row when you don't have Part D or another credited prescription drug plan under Medicare after your initial enrollment period ends, you will be faced with a late enrollment penalty added to your premium.
A number of factors influence how much these expenses will cost, including the types of drugs you choose, the plan you have and whether you use a pharmacy that is in your plan's network.
However, seniors may also qualify for financial help with these costs. Extra Help is a Medicare program designed to assist people with limited income pay for things like premiums, deductibles and copayments.
Choosing the right plan
With so many moving parts and different costs, it's important for seniors to choose the prescription drug plan that best suits their needs. The following are tips on how to select the plan that makes sense for you:
- Consider your prescription drug needs. Do you take many medications? Even if you don't now, it's smart to think about how your prescription drug needs may change in the future.
- Before switching to a Medicare prescription drug plan, consider whether you already have better coverage under your current insurance, such as the Department of Veterans Affairs or a union.
- Look beyond individual costs toward the bigger picture. A low premium may not count for much if the deductibles and copayments are high.
- The drugs you take or are most likely to take should act as a guide for the right plan. A more affordable prescription drug plan that doesn't cover your specific medications won't save you money.
- Determine what your coverage gap may be. Higher premiums may be worth it if they reduce the out-of-pocket costs you may face due to your coverage gap.
- Seek out help when making a decision. Besides the Medicare agency itself, the team at MySeniorHealthPlan.com is on hand to help you explore your options and find the information you need.