What You Ought To Know About Medicare Part D Coverage

Insurance Blog

Medicare Part D is an outpatient prescription drug benefit offered through government-approved private plans. This coverage applies to anyone with Medicare. It is available via a Medicare Advantage plan or a stand-alone prescription drug plan. Here are answers to some basic questions on Medicare Part D coverage.

How Do You Enroll?

If you haven't joined Medicare, you can do so in the initial 7-month enrollment period. It is advisable to find the appropriate Part D plan through the online plan finder. If you have any concerns about your Medicare Part D plan, consult a VICAP counselor. The counselor will help you choose the most appropriate option for your health care needs.

Who Pays for the Drugs?

Many Medicare Part D plans split the cost of drugs with beneficiaries through co-insurance or co-pays. For some plans, you must pay a specified minimum deductible before getting assistance with your drug expenses.

Remember that your co-insurance or co-pay limits may rise or fall. Your premiums and deductibles are also subject to change. In case of any changes, you will receive notification through the annual notice of change letter.

Drug costs also change depending on how they are rated in a tiered formulary. Low-tiered drugs are cheaper than high-tiered drugs. Your plan will notify you if your medication is moved to a different tier level.

How Do You Change Part D Plans?

The open enrollment period falls between Oct.15 and Dec.7. You can change to another Part D plan during the open enrollment period.

It is a good idea to compare your Part D options during the open enrollment period even though you are satisfied with your current plan. This is because these plans change coverage and costs every year. To determine the price for all the plans available in your area, key in your zip code and drugs in the Medicare Plan Finder.

When Should You Change Your Medicare Part D Plan?

One of the reasons to change your Medicare Part D Plan is if you hardly use it. If you don't have ongoing prescriptions for your current plan, switch to a lower-cost plan. Another reason to switch to another Medicare Part D plan is if your medication needs have changed. In this case, you should find a plan with a better deal.

Additionally, if the plan's formulary changes, consider switching to another plan. For example, if drugs in a lower tier are changed to drugs in a higher tier, it means your out-of-pocket expenses will increase. Remember, formularies change every year; therefore, make sure you stay updated with the changes. 


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