Medicare Drug Coverage
Looking for medical cover is sometimes a daunting task as there are several factors you need to consider. Having Drug coverage is one of them. When you visit a hospital or skilled nursing facility, you will more often than not end up with a prescription for drugs.
Some Medicare plans will allow you to have a hospital, medical and prescription drug package all in one. At other times you may need to combine different covers to have all the coverage you require. The search for the best plan is not always straightforward and may at times call for a lot of patience and shopping.
In this article, I hope to help you know your options for one-stop covers and also for combinations of covers. Ultimately, you will be an informed insurance shopper.
Should You Take Medicare Part D?
Unfortunately, Medicare Part A and B or the original Medicare, does not have a cover for medication. Once you have enrolled for the Hospital Insurance and Medical Insurance, you will need to get 2020 Medicare Drug Coverage or Part D of Medicare. Unlike Part A and B, Part D of Medicare is sold by Private insurance companies on contract to the Federal Government.
Your part D cover should essentially cover all vaccines that are commercially available should they be deemed necessary to prevent you from contracting an illness. You plan will decide which drugs it will include and which ones it will not and in which tiers they will fall.
Part D may not cover all the drugs required, but those that it pays for should be on a list made by your provider. The list of drugs that the plan D covers carries the name Formulary. A formulary can change at any time, but your insurance provider should furnish you with changes whenever they occur. Some of the drugs that by Part D will not pay for include but are not limited to medications for weight loss or gain, those for fertility treatment, medicine for erectile dysfunction, drugs purchased over the counter and also those used for hair growth or cosmetic procedures.
As a Medicare Drug coverage policyholder, you also have rights. You are entitled to receive in writing details about what your plan benefits are, how the cover works and any other requirements of the plan. You can also require your insurance provider for exceptions in regards to medication that is not included in your plan’s formulary and even waivers to plan coverage rules in some instances. If you find yourself in a position where you cannot take the generic medication that your insurance company pays for, you may request to pay a lower copayment amount for the more expensive medicine.
Does Medicare Advantage Cover Prescription Drugs?
Contrary to popular opinion, Medicare Advantage is not a different cover, but a part of Medicare also called Part C. To get this coverage, you need to be eligible for part A and B. Medicare advantage like part D of Medicare is available at private insurance companies.
The cost and components of Medicare Advantage plans are regulated by the government but still depend on the company from which you purchase your policy. Some Medicare Advantage policies may have Medicare drug coverage but if you buy Part D, your Part C provider will dis-enroll you from the plan, and you will go back to original Medicare.
If you are a high-income Medicare beneficiary, you may have to pay a high premium compared to those who earn lower than you. If you plan on taking up part D, you should do so as soon as you become eligible otherwise you risk paying a late registration penalty.
How does Medicare Drug Coverage Works With Other Insurance Plans?
Before you combine any medication coverage with Medicare, you should first find out if it is creditable or not. A creditable prescription medication coverage, Provides coverage for generic and brand prescriptions, gives a reasonable amount of access to retail medication providers and pays a minimum of 60% of your prescription drug costs. The plans should also not have a maximum benefit amount payable, and if it does, it should not be less than $25000 per annum.
Creditable prescription medication coverage plans should also pay at least as much as Part D of Medicare. The Medicare Modernization Act (MMA) requires all insurance companies selling policies which include prescription include prescription drug coverage) to notify member eligible for Medicare if their prescription drug coverage is creditable coverage or not.
Sometimes, you have another Prescription Medication cover, and you want to know whether or not you can keep it or if Medicare plans will do a better job. The answer depends on the cover, if you have coverage from a previous employer or even a union, you should consider the quality of the policy before taking up Medicare. Visit the providers from whom you would like to buy your drug coverage and check their formulary, compare it to the Medicare Part D and Medicare Advantage plans.
If you lose your job or for any other reason lose your employer or union plan coverage, you may qualify for Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits. If your COBRA plan does not have a creditable prescription drug coverage, you may be better off registering in a Medicare Part D Prescription Drug Plan in order not to risk paying the penalty for enrolling late.
What Plan Is Best For You?
So far, we have determined that you need a prescription medication cover of some sort. There are various options open to you out there. The most important thing is to compare the quality and cost of your options when deciding what will work best for you. Bear in mind that most drug covers come at an additional premium. If you have coverage and the time has come for you to join Medicare, you should also find out if your cover is creditable.
The Medicare Drug coverage plan or Part D is a transparent plan and will always show you what you will pay and update you when there are changes. It is essential to always check with your provider to ensure that they will pay for the drugs that you are required to use. You should also review different policies for coinsurance, copayment, and deductible if any. You need to know how much out of pocket costs you will incur and if any other provider will reduce the value.