Medicare: Review Your
Prescription Drug
Coverage
(part 6 of a series of 8 articles)
Prescription drugs are critical to health
and a significant expense for many people. This makes decisions about Medicare
drug coverage especially
important.
The most recent article in this series discussed the
need to understand your current Medicare coverage and any changes Medicare or
your plan may have made for 2014.
This article goes a little deeper into understanding your
current prescription drug coverage and what you need from
it.
How You Get Your Drug
Coverage
You have two ways to
get Medicare prescription drug
coverage.
- If you have a Medicare Advantage plan
(Part C),
your plan most likely includes drug coverage as part of the plan benefits.
Medicare Advantage plans also provide all the benefits of Original Medicare
(Parts A and B) and often additional coverage such as vision and dental
care.
- If you receive your Medicare benefits through Original
Medicare (Parts A and B), you may have purchased a
standalone Medicare prescription drug
plan (Part D) that provides your drug coverage. Original Medicare does not
cover prescription
drugs.
Medicare Advantage and prescription drug
plans are offered by private insurance companies where you live. You may have
many plans of either type to choose from, depending on your needs and where you
live. It’s important to note that with most Medicare Advantage plans, you are
unlikely to have or need a standalone Medicare prescription drug
plan.
Some Medicare Advantage plans and most
standalone prescription drug plans charge a monthly premium (in addition to the
Part B premium you pay to Medicare). Plans may also charge a deductible, and you
will likely pay a copay each time you fill a
prescription.
Check Plan
Formularies
Each plan, whether a standalone drug plan
or a Medicare Advantage plan with drug coverage, decides which drugs it will
cover. The list of covered drugs is called a “formulary.” Drug formularies may vary between the plans
offered where you live and from plans offered elsewhere in your state or in
other states.
Drug formularies are often “tiered.” A tiered formulary divides drugs into groups based
primarily on cost. A plan’s formulary might have three, four or even five
tiers.
Each plan decides which drugs on its
formulary go into which tiers. The decision is based on what the plan pays for
the drug. In general, the lowest-tier drugs are the lowest cost. Lower-priced
drugs are often listed as “preferred” drugs. Generic drugs are often lower-cost
drugs.
Review the plan details of your current
drug coverage and any other drug plan you may be considering. With a list of
your current medications on hand,
ask:
- Are
my current medications on the plan formulary?
- If my drug is not on the formulary, is there a substitute that would work for me ? (Ask your doctor to help with this.)
- What tiers are my medications in?
- What will I pay out-of-pocket (copay) for drug refills ?
You may want to write this information
next to each drug on your list of medications. Keep the list in your Medicare
file for reference as you narrow down your plan
choices.
For each plan, you will also want to
know:
- What pharmacies you can use. Some plans require you to use a
pharmacy within their contracted network.
- Whether the plan has a mail-order pharmacy benefit that may
save you money. You may be able to mail-order a 90-day supply of certain drugs
for a single copay.
Gavin
Walker
PH:
702-325-9585
Located inside
Vons in Anthem Tuesday, Thursday and Saturday from 9:30am-2:00pm
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