Prescription drug coverage is an important part of any comprehensive health insurance plan. However, as drug prices increase, many health insurance companies are putting more restrictions on the items they will and will not cover. This means even if you enrolled in a plan that has prescription drug coverage, you may still incur some extra costs out of your pocket.
The effects of these increases can be better quantified by evaluating CDC estimates which state that more than 48% of American adults use at least 1 prescription drug per month, 24% use three or more, and 12.6% use five or more1
How to get prescription drug coverage
Judging from the above insights, you may want to consider enrolling for a Medicare drug coverage plan even if you do not use prescription drugs now. Medicare drug coverage will help you pay for prescription drugs when the need arises.
Consider getting Medicare drug coverage as soon as you’re eligible, otherwise, you may be required to pay late enrollment penalties; unless of course, you have another credible coverage such as from a union or your employer.
To get Medicare prescription drug coverage, you need to choose a suitable plan from the approved provider in your area of service. Be sure to note all the costs including premiums, deductibles, and co-payments. Generally, your costs in a year will depend on the types of drugs you use and whether the provider has any drug restrictions.
Prescription Drug Coverage; Two enrollment options
A Medicare prescription drug plan (stand-alone Part D plan)
Most people who already have the Original Medicare prefer this option which involves purchasing a stand-alone Medicare prescription drug plan. As a requirement, all stand-alone Part D plans must cover the regulated list of commonly prescribed drugs. Each plan may however choose to work with specific brands. For you to qualify for this option, you need to have enrolled in Medicare Part A and/or Part B.
Medicare Advantage Plan (Part C)
Medicare Advantage Prescription Drug Plans (MAPD) is the second option of getting prescription drug coverage by Medicare. This plan typically comes with all the benefits you would get with Medicare Part A and Part B, and may also include additional benefits such as vision, hearing, and dental care. As a requirement, you first need to have enrolled for Part A and Part B for you to be eligible for the Medicare Advantage plan.
As earlier mentioned, the above two plans are only offered by selected private medical insurance companies which are approved by Medicare. Plans from different companies will vary in the costs included list of drugs covered and your area of service. Whichever plan you choose, always make sure that all the drugs you will need are well-covered.
You can compare the specific costs of the Medicare drug plan Vs Medicare Advantage Plan here2. If you are not sure which plan is best for you it would be advised to contact your local Medicare Agent for expert guidance on the matter. Additionally, you may need to contact your doctor and create a list of all you required drugs before deciding.
Once you’ve decided on the suitable Medicare Plan, you will be required to fill out a form on the website, providing details like your Medicare number, and the dates you enrolled for Part A and/or Part B.
Things to Note before Joining:
- Learn how the new prescription drug works with any other existing drug coverage you have
- Compare your current drug coverage with Medicare Prescription Drug coverage, keeping in mind that your current coverage may change moving forward.
- Before you make any changes to your existing drug plan, talk to your plan provider, insurer, or benefits admin for advice.
Choosing the right coverage can be confusing and it would be advised to consult with a professional before making any decision. This will ensure you avoid any penalties and unnecessary cost.
- Centers for Disease Control and Prevention. Therapeutic drug use. Updated 2018. https://cdc.gov/nchs/fastats/drug-use-therapeutic.htm