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How Do I Get Medicare Part D Prescription Drug Coverage?

Medicare Beneficiaries can obtain their prescription drug coverage in two different ways. The first way, if they remain on Original Medicare, is to enroll in a Part D stand-alone Prescription Drug Plan (PDP). These plans are offered by private insurance companies. They can vary in the premium cost of the plan, the annual deductible amount, the formulary (the list of drugs covered and how) and the copay for each prescription. Each company may offer more than one plan, which may make things a little more confusing.


One thing to keep in mind when comparing the plans is that the less expensive monthly premium PDP plans most likely have a high annual deductible for the name brand drugs. So, what seems less expensive up front might not be the case later on. Likewise, a plan with a higher monthly premium may eliminate the deductible, and also cover more expensive drugs better. In addition, I tell my clients to be careful about the really inexpensive plans, because they may run into problems in the future with certain drugs not being covered.


The second way is to enroll in a Medicare Advantage Plan (MAPD), which includes Prescription Drug Coverage as part of the plan. The cost of the prescription drug coverage is included in the monthly premium of the Medicare Advantage Plan, which may start as low as $0 premium cost. Similarly, copays and formularies can vary, from company to company, as well as from plan to plan within the same company. Potentially, out of pocket costs can vary by hundreds of dollars or more.


In all the Part D plans, PDP’s or MAPD’s, drugs are assigned to a tier level. Tier levels typically group drugs into categories like generic and name brand, preferred and non-preferred, and specialty drugs. The tier assignment for a drug can vary from company to company, and plan to plan, even within the same company, depending on the plan’s formulary. This means that in either case, there is research that needs to be done. Beneficiaries need to have the correct spelling, the dosage, and how many times per day the medication is taken. When researching liquids, gels or drops, it is important to know solution strength and how many bottles or tubes are ordered per month. Many of my clients have found this task to be confusing and oftentimes challenging because even the pharmacy you shop at can affect how much you pay. Clients may need to be flexible when choosing where to purchase their prescriptions, including the mail order option.


Lastly, an interesting thing that I have come across is that sometimes the copays for the drugs are less expensive inside a Medicare Advantage Plan than in a stand-alone plan. It is worth the comparison. Please call us at 631-337-3625 for help. This is what we do with no charge to you for our services.



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