Medicare is a social insurance program administered by the US federal government which provides health care insurance to Americans who are 65 years old and above and to younger people with a disability or those who are afflicted with certain types of diseases. Its package of benefits coverage is divided among four parts namely Parts A, B, C, and D. This article will focus more on Medicare Part D in 2018, or Medicare Prescription Drug plan, which helps cover the cost of prescription drugs by helping lower its cost and protect the covered beneficiary against higher drug costs in the future.
Here is a short overview of what the other parts of the Medicare program cover. Medicare Part A covers hospital inpatient care, skilled nursing facility care, home health care, and hospice care while Part B covers services provided for beneficiaries who are treated in a hospital as an outpatient. Furthermore, it also provides preventive services to detect and prevent illnesses and disability at an early stage, as well as wellness program where a personalized plan is developed and updated to help the beneficiary stay healthy.
Part C, which is also called as Medicare Advantage Plan, includes all the benefits coverage under Parts A and B, and may even include Part D Medicare coverage. Since this plan is run by Medicare-approved private insurance companies following Medicare’s set of rules, it may also include extra benefits and services not included in the original Medicare, for an additional cost.
Signing up for Part D Medicare 2018
Everyone who has Medicare coverage can get prescription drug coverage. To get a Part Medicare coverage, a person must sign up for a plan under an insurance company or from other private company approved by Medicare. Keep in mind that different plans under different companies will vary in cost and in the list of drugs covered.
Once a person becomes eligible to join for a Medicare drug coverage, he must get one right away even if he is not taking any prescription drugs at the moment to avoid paying late enrollment penalty when he decides to join later.
There are two ways to get prescription drug coverage. First is by signing up for a Medicare Prescription Drug Plan. These plans add drug coverage to Original Medicare, some plans under Medicare Cost Plans, Medical Private Fee-for-Service Plan, and Medicare Medical Savings Account Plans.
The second way is by joining a Medicare Advantage Plan or other Medicare health plan which integrates a Medicare prescription drug coverage. But to be eligible for a Medicare Advantage Plan or Medicare Part C, a person must have Parts A and B.
Before joining a Part D Medicare plan, consider checking first other drug coverage you may already have because getting a separate one may affect the one that you already have.
What does Part D Medicare in 2018 cover?
Each different Part Medicare plan has a different set of ‘formulary’ or list of covered drugs. A prescription drug may fall into the various tier, depending on the plan and if it is on a lower level, the said drug will cost less than those medicines which are in a higher tier. A plan may change its formulary within the year, according to the guidelines set by Medicare.
What will a person pay for a prescription drug plan?
The actual cost of a Part D Medicare plan will vary depending on different factors. First is when the drugs prescribed are included in your plan’s formulary and depending on what tier it belongs to. The second element depends on the plan itself, which has the tendency to change its’ cost within the year. The pharmacy where your medicines is also a factor that affects the cost of the drug coverage plan.
A person will have to pay a monthly premium for a drug coverage plan on top of the monthly premium paid for Part B Medicare. The monthly premium paid for Medicare Advantage Plan or a Medicare Cost Plan may already include payment for prescription drug coverage.
Deductible, copayment, or coinsurance
Most drug prescription coverage plans do not require a deductible, but for those who have one, this is the amount a person will pay before the plan begins covering the prescription drugs. Copayment or coinsurance, on the other hand, is the amount the person pays as his share of the prescription drug. The amount also varies according to the actual cost of the drug.
A person will need to pay for the coverage gap as soon as the plan has spent for a certain amount of drugs. However, not everyone will have a coverage gap since the medicines which are prescribed for them may not cost that high.
Late enrollment penalty
If a person decides to get a Part D Medicare plan after his Initial Enrollment Period was over and he had 63 days or more where he had no Part D or other creditable prescription drug coverage, an amount which corresponds to a late enrollment penalty will be added to his Part D premium. He will have to pay that amount for as long as he has a Part D coverage.
Part D Medicare in 2018 generally observes the following rules before filling up a prescription. The covered person and the doctor or practitioner prescribing the drugs should be able to show proof that the medication is medically-necessary for his condition. They must secure prior authorization from the drug plan before the said drug could be covered. The plan will also look at the quantity limits of the medication, and he must try one or more similar but lower-cost drug before the policy covers the prescribed medicine.
Drug coverage plans also provide Medication Therapy Management to qualified members to help them understand and manage their medications. A pharmacist or a health care provider will discuss with the eligible member how well the medicines are working and if they have side effects or interactions with the other drugs that the member is taking if there are any. They may also discuss other problems the member might have in relation to the prescribed medications he is taking.