If you’re about to turn 65 or have recently celebrated the milestone, you’re now eligible to enroll in Medicare. A common question is whether Medicare will cover your current prescriptions. Fortunately, there are two primary ways to ensure your medications—both current and new—are covered, and everyone with Medicare Part A or Part B can take advantage of these options.
Medicare offers optional prescription drug coverage through private insurers, regardless of your income or health status. If your income is limited, you might also qualify for a program known as “Extra Help.” However, if you delay enrolling, you could face a late enrollment penalty that lasts as long as you have prescription drug coverage. Before enrolling, compare your current health insurance drug benefits with Medicare’s offerings, as your existing plan might provide better coverage or could change when you switch.
There are two ways to receive Medicare prescription drug benefits:
- Medicare Advantage Plans (HMO or PPO): These plans include prescription drug coverage along with other Medicare benefits.
- Medicare Part D Stand-Alone Plans: These are dedicated drug plans that provide coverage if you have Original Medicare.
Each plan comes with a formulary—a list of covered drugs that includes both generic and brand-name options. Make sure to check if the medications you need are on the formulary; if not, your healthcare provider might be able to request an exception. Keep in mind that formularies can change yearly due to new research and emerging drugs. If you choose a medication not listed, you’ll likely pay the full cost without the benefit of coinsurance or copays.
Also, be aware of the Medicare Part D “doughnut hole” or coverage gap. Once your annual drug expenses exceed a certain limit, you enter this gap. Thanks to discounts provided by the Affordable Care Act, you aren’t responsible for 100% of drug costs during this phase.
You can enroll in Part D coverage during several periods each year:
- Annual Open Enrollment (October 15 – December 7): Enroll for the first time if you missed your Initial Enrollment Period (IEP) or Special Enrollment Period (SEP), or if you’re switching plans.
- Annual Disenrollment Period (January 1 – February 14): Opt out of a Medicare Advantage plan and return to Original Medicare, or join a stand-alone Part D plan if you’ve had drug coverage through a Medicare Advantage plan.
- Late Enrollment Period (January 1 – March 31): If you missed signing up for Medicare Parts A and/or B during your IEP or SEP, you can enroll during this period, with coverage beginning on July 1. You can then choose a Part D drug plan or Medicare Advantage plan between April 1 and June 30 to start receiving drug coverage on July 1.
Understanding your Medicare prescription options can help you make informed choices about your healthcare coverage as you step into your senior years.
Medicare Open Enrollment
Oct 15-Dec 7
Bruce Gleason
Medicare Lic. # 7279927 | (716)708-9943 | https://medcarevalue.com/BruceAGleason
Article sourced from MedCareValue