Rising prescription drug costs are an enormous burden for seniors and disabled persons, especially those paying for multiple medications on fixed incomes. That’s why Medicare Part D prescription drug coverage emerged in 2006 as a supplement to traditional Medicare coverage. This optional coverage can help lower prescription drug costs and protect against higher costs in the future.
Q & A on Coverage
Q. Who qualifies for Medicare prescription drug coverage?
A. Everyone with Medicare coverage is eligible for Medicare Part D.
Q. When am I eligible for Medicare prescription drug coverage?
A. You can sign up for Medicare Part D when you first become eligible for Medicare. If you didn’t enroll when you were first eligible, you may pay a penalty,* and your next chance to enroll is from Oct. 15 to Dec. 7, 2013.
Q. Are there multiple options for coverage, or just one plan?
A. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage. There are hundreds of prescription drug coverage plans across the country, and you may have dozens of plans available in your state. These plans are run by insurance companies and other private companies approved by Medicare. The plans can offer a standard benefit or vary it, as long as the coverage is equal to or better than Medicare’s set guidelines.
Q. How do I know if my prescription medications are covered by the plan?
A. Before enrolling in a prescription drug plan, ask about the plan’s formulary, or list of drugs the plan covers. Most generic and brand name drugs are covered, plus insulin, insulin-related supplies, certain vaccines and smoking cessation agents. Still, it is important to check that your prescription drugs are on the list.
Q. Can I fill prescriptions at my local pharmacy?
A. Your preferred pharmacy may not accept every plan’s coverage, so it’s worth a call to make sure the plan includes a pharmacy that is convenient for you. Some plans also offer mail order programs, which deliver the medications directly to your home.
Q. How much does it cost?
A. Most drug plans charge a monthly premium (in addition to the Part B premium) that varies by plan. Your costs depend on which drugs you use and which plan you choose. If you have limited income and resources, you may get extra help to cover prescription drugs for little or no cost. Choosing a plan that fits your situation allows you to get the coverage you want at the best price possible.
Q. How much can I expect to pay out of pocket?
A. Most drug plans have included a coverage gap (sometimes called the "donut hole") in which the individual is responsible for 100% of drug costs. In the 2013 standard Medicare prescription drug benefit, the gap is between $2,970 and $4,750. That means once your drug costs total $2,970, you may be responsible for 100% of your drug costs until they reach $4,700, after which they are covered at 95%.
Q. Which plan is right for me?
A. The Medicare Prescription Drug Plan Finder, available at medicare.gov or 1-800-MEDICARE, can personalize your search and help determine your best plan option through a side-by-side comparison.
* Penalty does not apply if you currently have “creditable” drug coverage (that which meets or exceeds the Medicare Part D guidelines), as determined by Medicare.