Medicare Part D is insurance for your prescription needs. When enrolled in Medicare Part D, you pay a monthly premium to your Part D plan’s insurance carrier. You then use the insurance carrier’s network of pharmacies to purchase your prescription medications.
Medicare Part D allows you to pay a copay or percentage of your drug’s cost instead of paying your prescriptions full price. Each plan varies in cost and the drugs covered, but all Medicare Part D plans follow federal guidelines, and every insurance career will submit its plan outline to the Centers for Medicare and Medicaid Services yearly to be approved.
Drug Coverage
Every Medicare Part D plan has a list of drugs covered, called a formulary. If the drug you need is not on the formulary, you may request an exception, pay out-of-pocket, or submit an appeal. Because each formulary varies from plan to plan, ensure you request a copy to make sure you are on a plan that covers the drugs you will need.
Each plan has to cover all drugs in the following categories:
- Antidepressants
- HIV/AIDS treatment
- Immunosuppressants
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Anticancer drugs (unless they are being covered under Part B)
Many companies offer Part D plan options, and you will likely have a variety of different choices. Big brands in the health insurance industry offer Medicare Part D Plans, such as Blue Cross and Blue Shield, Aetna, Humana, and smaller companies. Some plans will use a pharmacy network, so if there is a pharmacy you regularly use near you, make sure that it is a part of your plan’s network.
Certain prescription drugs are not covered under any prescription drug plan:
- Weight loss or weight gain drugs
- Drugs for hair growth
- Fertility drugs
- Drugs for erectile dysfunction
- Over-the-counter drugs
Medicare Part D Enrollment Options
Your first opportunity to enroll in Medicare Part D is during your Initial Enrollment Period or IEP. This is the time you first become eligible for Medicare, three months before you turn 65. This includes your birthday month and the three months after. During these seven months, you can enroll in Medicare Part D.
Your second opportunity to enroll in Part D is during the Fall Open Enrollment Period or OEP, which goes from October 15 to December 7 every year.
Make sure to enroll in a plan when you are first eligible to avoid a penalty for being late added to your monthly premium. Without prescription drug coverage, you’ll pay a penalty of 1% of the national base premium for every month you go without coverage, for as long as you have Medicare Part D coverage.
Do I Have to Enroll in a Part D Plan?
Part D is voluntary, meaning you can choose whether or not to enroll. However, you should not think about just the medications you are currently taking but also those that you may need in the future. Remember that medications can cost thousands of dollars, and we never know when we may need them.
If you have any questions, give Temmen Insurance a call at 417-633-7200.