Medicare is divided into four different parts: Part A, Part D, Part C, and Part D. Each of these four parts offers different benefits and is geared towards Medicare beneficiaries with different needs. However, some of these parts can be used together. Medicare Part D – the prescription drug option – can be used along with Medicare Part A and Medicare Part B.
Additionally, Medicare Part D can be used in conjunction with a qualifying Medicare Advantage plan. In order for participants to have a Medicare Advantage plan that qualifies for Medicare Part D coverage as well, the Advantage plan cannot already provide prescription drug coverage.
When a Medicare subscriber has the stand-alone Medicare Part D plan, the participant will most likely have to pay a monthly premium for the drug plan, co-payments, co-insurance, and a deductible. All Plan D plans may vary from provider to provider, so Medicare participants should be sure that they are aware of the specifics of their own plans.
Here are a few additional things that Medicare subscribers need to know if they are considering enrolling in a Medicare Plan D program:
- The Medicare Plan D program only covers medications that are listed on the formulary. The list of medications may change throughout the year, as long as the Centers for Medicare and Medicaid Services approve the changes. In the event that medications are changed on the formulary, these changes need to be posted on the Centers for Medicare and Medicaid Services Web site at least 60 days prior to the effective date of the changes.
- In the event that a Medicare Plan D beneficiary requires a drug that is not listed on the formulary, the beneficiary can request that Medicare make an exception in order to cover the non-formulary drug. There is also an appeals process if the request is denied.
- The drugs included in Medicare Plan D coverage do not include non-prescription drugs, including drugs for weight loss or gain. The formulary also does not include prescription vitamins. However, the cost of these drugs will go towards the out-of-pocket minimums.
- The standard initial annual deductible for Medicare Plan D plans will be $305 in 2010. This plan will cover 75 percent of up to $2,405 medication costs. After this total has been met, the beneficiary must pay $6,153.76 or more towards medication costs before the program begins coverage again.
- If a Medicare beneficiary wishes to change Medicare plans, he or she can do so during the annual open enrollment period, which lasts from November 15 to December 31. During this period, any changes need to be made for the upcoming year.
In addition to Medicare Plan D, many Medicare subscribers enroll in Medicare Supplement Insurance or Medigap programs, which may also help to cover the cost of medications or other gaps that are not covered by the Original Medicare plans.
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.