A Medicare Prescription Drug Plan, Medicare Part D, helps you to get the coverage you need for your prescription drugs. If you feel you will need this and you don’t have any other creditable prescription drug coverage, the best option is to sign up when you are first eligible for Medicare; otherwise, you might have to pay a late penalty fee.
You can get prescription drug coverage in two ways:
- Join a Medicare Prescription Drug Plan, or PDP;
- Join a Medicare Advantage Plan, Plan C, which also offers drug coverage.
Factors affecting the cost of your prescription drugs:
What a particular PDP covers varies; each plan has its own formulary, or list of covered drugs. The cost of types of drugs often varies depending on what tier, or level, it is in. Lower tier drugs will cost you less than high tier drugs, but it is sometimes possible to get exemptions to high drug costs.
- Whether the drugs are on your plan’s formulary, and which tier they are on;
- Whether you go to a pharmacy that is part of your plan’s network;
- Whether you have the documentation that qualifies you for Extra Help.
- If you enroll in a Medicare Prescription Drug Plan you will have to pay the following costs:
- The monthly premium for your plan;
- The yearly deductible, if there is one in your plan;
- Copayment or coinsurance, which is a set amount or percentage of the cost of the drug you pay after the deductible has been reached; this will vary depending upon the drug’s tier;
- The extra cost of drugs after you have reached the coverage gap;
- The late enrollment penalty you pay if you didn’t join a PDP when you were initially eligible.
There are several things you should consider in order to decide if your Part D formulary meets your needs, including your lifestyle, medical history, and plans for the future, and, more particularly, whether any prescription medication you require or will require is on your plan’s formulary. If after contemplating these factors carefully you decide your present plan doesn’t meet your needs, then it’s time for a change.