Healthcare is indeed a costly affair in the US and having insurance companies cover for majority of your expenses is the best thing you can do. The Medicare program is a social insurance program that works in this regard along with 30-50 private insurance companies across the US. While Medicare Part A and B plans cover hospital insurance and medical insurance respectively, you need a separate plan i.e. Medicare Part D plans for prescription drugs. The original Medicare parts A and B do not cover prescription drugs and paying for all your prescription drugs by yourself is not a joke. In this article we will discuss the most basic things you need to know about Part D plans, the benefits it offers and the restrictions it comes with.
7 Things to Know About Medicare Part D Plans
1. You are eligible for a Part D plan if you have either of Part A or Part B plan with you. You must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD) to avail the benefits of Part D plans.
2. Unlike Part A or Part B plans, you are not offered a standardized insurance plan for prescription drugs under Medicare Part D plans. You have to choose the plans which cover the drugs you require by going through the tier of medicines the plans cover and drugs not covered by the plan.
3. Generally, Part D plans don’t cover the drugs covered under Part A or Part B which are given by a hospital or doctor after the visit. The plan also doesn’t cover non-prescription drugs like Viagra, weight loss/gain drugs or drugs for cosmetic purposes, hair growth and fertility promotion.
4. All Medicare Part D plans have a monthly premium which varies depending on the insurance company offering the coverage. Currently, the average nationwide premium is $34.00. Apart from the monthly premium, there is also an annual deductible on certain plans which offer higher tiered drugs.
5. There is a temporary limit on how much Medicare Part D plans cover for you. Once your drug expenses reach a certain amount ($3750 for 2018), you enter the coverage gap meaning you pay 44% of co-insurance on generic drugs and 35% in brand name drugs.
6. Each Medicare Part D plan has a designated network of contracted pharmacies. While choosing a plan you have to be careful and ensure that the plan you choose has the pharmacies you visit under the plan. If you visit a pharmacy that is not included in the plan, it will be considered out-of-network and your co-insurance will be more on this one.
7. You can enroll for a Medicare Part D plan under an Initial Enrollment Period (IEP). This period will include will your birthday month, in addition to 3 months before and 3 months after your birthday month. You can also enroll yourself during a 2-month Special Enrollment Period (SEP) or the Annual Enrollment Period (AEP), which starts October 15th through December 7th.
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