There are so many Parts to Medicare! You don’t want to overlook Medicare Part D- Prescription Drug coverage.
Wondering what portion of Medicare covers Prescription Drugs??
Look no further! Medicare Part D Prescription Drug plan sounds confusing but it's simple...
Medicare Part D is the strange name of the insurance plan which covers outpatient RETAIL PHARMACY & MAIL ORDER prescription drugs.
Unlike your old health plan, Medicare has prescription drug coverage completely separate from the health plan.
Under Original Medicare, unlike Medicare Advantage prescription coverage is purchased through a separate insurance carrier vs. your Medicare medical plan which covers Hospital and Doctor's Office visits among other expenses.
With rising health and medication costs, having a Part D plan will help you minimize your prescription drug expenses.
- You can only get a Part D prescription plan through a private health insurance company.
- The Part D RX plan or also know as Medicare PDP (Prescription Drug Plan) coverage is purchased separately if buying Original Medicare, and bundled typically on Medicare Advantage Plans.
Many customers who don't currently take any prescriptions wonder if it is better to skip enrolling in the Medicare Part D prescription plan initially, and save the premiums until they need a plan.
What is our advice??
We resoundly endorse enrolling in a Medicare Part D at the period of initial eligibility. Why??
The Medicare Part D late enrollment penalty never ends. That's right!!
You pay additional fees for Medicare Part D for life.
Here's the penalty description from the CMS Medicare website, and an example.
Uh, say what?
Sounds confusing but it's really not. This simply means you pay 1% x the base plan premium = $33.06 x the number of months you go uninsured.
Let's say the number of months is 36 as an example.
This means 1% * 33.06 * 36 = $11.88 is the penalty per month added to your premiums.... which you'd pay forever as long as you are enrolled in Medicare.
You may also qualify for a different type of enrollment period called a Special Enrollment Period.... or SEP
- Have Part A and or/Part B (Enrolled)
- AND... live in a Part D service area
Each Part D plan has a list of covered Prescription drugs, also known as a Drug Formulary List.
If your particular prescription drug is not on the insurance carrier drug formulary list of the Part D carrier for the plan you choose you have options.
- you may request an exception through a 'prior auth' process
- pay out of pocket
- file an appeal with your insurance carrier
- during the initial 12 months after your Initial Enrollment Period you may request a plan & insurance carrier change
All Part D plans must include at least two drugs that treat the same symptoms or have similar effects. Part D must also include at least two drugs from most categories and must cover all drugs available in the following categories:
- Anticancer (if not covered by Part B)
- HIV/AIDS treatments
- Most Vaccines (if not covered by Part B)
Keep in mind the Medicare Part D insurance carrier can change the formulary list any year. The Medicare Part D insurance carrier will warn you prior if this is happening.
Let us know if you need help with a Medicare Part D prescription question and we'll find the best solution for you!
Certain medications NOT covered by Medicare Part D consist of:
- Over the counter, non-prescription drugs
- Vitamin supplements except for prenatal and fluoride preparations
- Cosmetic purposes/hair growth
- Cold and Cough symptoms only drugs
- Anorexia, weight loss or weight gain (may cover drugs used to treat physical wasting caused by AIDS, cancer or other conditions)
Some of the prescription drugs listed above may still be covered if they are being prescribed to treat other conditions.
Let us help you with you Medicare needs!
- Find out when you need to enroll
- Steps and Information needed to enroll
- Eligibility requirements
Interested in MAIL ORDER prescriptions filled for a maintenance medication?
Mail Order is available at nearly all Medicare Part D Insurance plans for maintenance medications which are:
A) listed on the drug formulary list as 'covered medication' &
B) taken on a maintenance basis.
This gives you an extended amount of medication and the convenience of avoiding multiple trips to the pharmacy.
Some insurance carriers will offer preferred coverage at specifically contracted Pharmacies.
Check with us to get help looking up your preferred pharmacy and Medicare Part D plan.
This depends on your Medicare Part D plan and insurancecarrier. This may SAVE YOU MONEY and time!!
A lot of people ask us if they can skip Medicare Part D prescription plan enrollment entirely and avoid the premium costs.
We get it... if you aren't taking any prescriptions you may think you'll NEVER need them and nothing bad will ever happen to you health wise.
There's 2 typical scenarios where you can avoid purchasing a standalone Medicare Part D RX plan:
If you have a Medicare Advantage plan enrolled with a Medicare Part D RX plan bundled (which most of them do), then you CANNOT legally enroll in a separate Medicare Part D prescription plan.
If your actively enrolled employer, union, retirement plan, etc. offers you a prescription drug plan which is considered Medicare Part D Creditable.
Call for a Complimentary Medicare Consultation
We understand Medicare is very new to you and gets overwhelming quick with WAY TOO MUCH DATA.
Sometimes is easiest just to pick up the phone, explain your situation, questions, needs and concerns.
We are happy to have that conversation with you!
We will be happy to schedule a call at your earliest convenience.
Or, utilize self service and shop yourself online
Medicare Part D premium costs and out of pocket expenses still look too expensive for your income?
Do not fear!
Medicare has a low income subsidy assistance program called "Extra Help."
What is involved with the Medicare Part D 'Extra Help' low income subsidy?
Medicare offers a low income subsidy to assist with both premiums and medical expenses if your income is beneath certain levels vs. the Federal Poverty Level "FPL".
In short, it reduces your costs.
CMS Medicare will examine your income and assets to determine if you qualify.
You can check the current annual income and asset limits at www.medicare.gov anytime
Income and assets which count towards the annual limit are:
- Cash, savings, and checking accounts
- Investment accounts such as stocks, bonds, & annuities
- Retirement accounts & diversified investments like mutual funds
- Real estate (but not your primary residence)
To give you an idea of income qualification limits, the 2021 limit annually for an individual is $19,140.
This number will change each year, of course, based on the FPL Federal Poverty Level.
To apply for Extra Help there are many options.
You can apply online here.
Or, you can phone Social Security at 1-800-772-1213 to apply over the phone or ask for a paper application to be mailed.
You can also visit your local Social Security office in person to apply face to face.
What information should you gather when applying?
It's useful to get your personal finances together prior to submitting your application.
You will need information regarding:
- Real Estate other than primary residence
- Value of bank accounts, checking, savings, CD's, stock investment accounts, mutuals funds etc.
- Annual Income on tax returns
- Rental Income
- Retirement income such as 401k, pension, Railroad Retirement, Military
- State Income: Disability, Social Security, Workers Compensation
- Regular w2 or net self employment income
How is this verified?
Medicare will run a quick systems check with government agencies to confirm your application so necessary documentation will be little to none.
But, since you need to submit accurate information you need to gather your financial documents together.