Index | Medicare | Drug Coverage
Prescription Drug Coverage (Medicare Part D) pays for the expenses connected with medication that doctors prescribe for treatment. Given a wide range of people with different health care needs qualifying for Medicare, there are viable options to satisfy your requests.
There are two types of plans providing Drug Coverage. You can get drug coverage through one of the plans that provide merely prescription drug coverage. These are Prescription Drug Plans (PDP), also referred to as stand-alone prescription drug plans. The other way to get Drug Coverage is through Medicare Advantage Plans or Medigap policies. The Medicare Advantage Plans which offer prescription drug coverage are known as Medicare Advantage - Prescription Drug (MA-PD) Plans. To qualify for Prescription Drug Plans of any type (PDP or MA-PD) you are to be entitled for both Medicare Part A and Part B.
Whatever plan you opt for, Medicare Drug Coverage will help you by covering brand-name or generic drugs. All the drugs are categorized and listed in the plan's formulary. Formularies typically include such categories of drugs as antidepressants, anticonvulsants, HIV drugs, immunosuppressants, cancer drugs, antipsychotics and some others. The general rule states that there must be at least two drugs of each category on the formulary, otherwise the whole category is excluded. Certain categories of drugs are initially not covered by Prescription Drug Plans, such as over-the-counter drugs, Valium, weight regulation drugs, hair loss drugs, barbiturates, etc.
Remember that plans vary noticeably in the benefits they offer and charges they bill. Some of them offer more coverage and a wider range of prescription drugs resulting in a higher monthly premium.
Signing up for Medicare Part D is important as we all depend on drugs when we are ill, and it often admits of no delay. Your premiums may depend on the time of your enrollment. In terms of financial investments Drug Coverage can be quite costly, but it protects you from potentially greater expenses in the future. Choosing a Prescription Drug policy to add to your coverage, you are required to pay a yearly deductible ($265 for 2007) and monthly premiums, as well as sometimes to share the costs of medication through coinsurance and co-payments.
There are a number of points to bear in mind when deciding whether to enroll in Medicare Part D. For example, you may already have Drug Coverage through your own private health coverage plan. If you have prescription Drug Coverage from your current or former employer you may not need to sign up for Medicare Part D, because the plan you are on may well cover the same benefits. If you sign up for both Medicare and Medicaid, you receive the so-called dual coverage which ensures your automatic prescription drug coverage through Medicare starting on January 1. If you have a modest income, you can receive the Low Income Subsidy, which pays for the plans with a premium below a fixed level. If you qualify for extra help for people with limited incomes and resources, Medicare may reimburse you for all your prescription drug costs.
It is recommended to check the details of coverage carefully as some of the plans may not offer the drugs you need. It can be helpful to make a list of the drugs you need, the brand names offering them, possible substitutes for each drug, dosage amount and dosage schedule. Then you can easier tailor a plan to your needs. Remember that plans may change year to year, therefore, it is advisable to check your coverage on a regular basis to make sure that your Prescription Drug Plan, either PDP or MA-PD, still meets your needs.
You must know that your drug coverage plan can choose the drugs to offer to the beneficiaries and correspondingly take off certain drugs of the formulary. In this case you are to receive a notice 60 days before the old coverage stops. The situation may have some solutions. You only need to choose the one that suits you most. You can ask your insurance company to cover the drug for a higher premium. The situation is known as exception. In this case your physician is to certify the necessity of this particular drug for your diagnosis. The company may refuse to extend your plan by including the drug in question. If your application is denied, you can appeal the decision through a series of instances.
Another way to get your Drug Coverage is to switch to another plan which has the drug in question on its formulary. It is important to speak to an insurance agent to make sure when you are allowed to switch to another plan. You may do it either once a month or within an established period.
Convenience is also a determining factor in choosing a prescription drug plan. Check up what pharmacies are part of the plan and whether they accept mail orders.
Prescription drugs are an essential component of health care. Medicare Prescription Drug Plans, both PDP and MA-PD, can ensure tangible protection against unexpected drug expenses, which are sometimes soaring, and excessive drug bills in the future. As we grow older, most of us need drugs to maintain our health. Even if now it seems you are perfectly healthy and do not need to think about Drug Coverage, it is sensible to consider joining.