Prescription drugs are an important component of medical treatment, and the costs can be coupled with your Medicare coverage plan. Medicare Part D specifically aids in the payment for prescription drugs. You may not currently need prescription drugs, but this type of coverage makes them more affordable if you ever do. There are different individual prescription drug plans that you can consider, and you can work with a McCunis-Fox agent to discover which plan works best for you. Understanding what is included in Medicare Part D will help you decide what works best for your Medicare coverage plan.
Prescription Drug Plans
Does Medicare Part D Cover Prescriptions?
All plans under this insurance coverage include a broad range of prescription drugs typically taken by participants in the Medicare program. The majority of the drugs in the protected classes are covered as well. These include HIV/AIDs and cancer therapy drugs. Most generic drugs are covered by this plan as well. The Food and Drug Administration (FDA) categorizes generic drugs as brand-name drugs or those that are similar to brand-name style formulas found in the same categories. This means that the same active ingredients found in brand-name prescription drugs are the ones that will need to be found in drugs covered by this plan. Every plan has its own formulary, which itemizes what particular drugs are included. Most Medicare plans will also place drugs into tier levels on their formularies to show which level of coverage include which specific drugs. The lower tiers are less expensive than the higher tiers, but also include fewer prescription drugs.
What Prescription Drugs Are Not Covered?
There are some medications that are not covered by Medicare Part D. This includes prescriptions that are not typically utilized for a medically accepted reason. If it is not approved by the FDA, it won’t be covered either. It also won’t be included in the plan if it is sold outside of the United States, even if it is popular in another country. Lastly, the drug won’t be covered if it is sold over-the-counter and is a non-prescription drug. This can include fertility medications, cough syrup, cold medication, cosmetic medications, hair growth treatments, weight loss or gain medications, as well as pills for sexual dysfunction (if there is a medical condition for sexual dysfunction, it may be excusable and considered within prescription drug plans). Nutritional supplements and vitamins are also not covered.
What is the Best Medicare Part D Prescription Drug Plan?
There is no best prescription drug plan, except one that works best for your particular circumstance. You can compare Medicare Part D Plans to help you choose. For example, if you take a lot of generic prescriptions, you can go through the tiers to understand which ones will cover what you need for the most affordable rate. If you take specific drugs, check the formulary list of each drug plan. If you need some help with the high costs of expensive drug prescriptions, you can pick a plan that has a coverage gap offer. This is so that it can cover your drugs during the gap between when you are and aren’t using them. For prescription drug plans for seniors, this works exceptionally well. If you would like lower costs and extra benefits, you can balance this with more restrictions on which hospitals and doctors you use. This would work for the Medicare Advantage Plan Part C with prescription drug coverage. If you want coverage just in case you need it in the future, and to avoid late penalties, you can enroll in a low monthly premium drug coverage program.
Understanding what is included in Medicare Part D will help you decide what works best for your Medicare coverage plan.
How Much Does Part D Pay for Prescriptions?
When paying for a Part D premium, it always goes by yearly income. If you make less than $88,000 individually and $176,000 jointly, you only pay for your plan premium. When you make between $88,000 to $111,000 individually and $176,000 to $222,000 jointly, the plan will cost $12.30 plus the plan premium. If you make between $111,000 to $138,000 individually and $222,000 to $276,000 jointly, the plan will cost $31.80 plus the plan premium. In higher tiers, when you make between $138,000 to $165,000 individually and $276,000 to $330,000 jointly, the plan will cost $51.20 plus the plan premium. Also, when you make between $165,000 to $500,000 individually and $333,000 to $750,000 jointly, the plan will cost $70.70 plus the plan premium. Lastly, when you make above $500,000 individually and above $750,000 jointly, the plan will cost $77.10 plus the plan premium.
How Do I Enroll Into Medicare Part D?
To enroll in this coverage plan, you will have to enroll when you’re first eligible and applying for medical coverage of any kind. If you aren’t covered by another drug plan, for example through a union, you will have to pay a late enrollment penalty for as long as you have the drug coverage. There are two ways to enroll. The first approach is to have Medicare Part A or Medicare Part B insurance coverage before you add on the drug coverage. The other approach is to have the Medicare Advantage Plan, also considered to be Part C, to obtain the drug coverage. However, to be enrolled in Part C you must be in Part A or Part B.
When you are ready to enroll in the appropriate insurance coverage plan, you can work with a knowledgeable agent who will guide you. Contact McCunis-Fox today so we can help you review which plan will work best for you.
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