Understanding Your Benefits: Medicare Drug Coverage

Post Date: November 2018  |  Category: Medicine Senior Health

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Find out everything you need to know about Medicare Part D prescription drug plans.

Medicare, the federal health insurance program for people over 65, comes in many options—each one covering different services. Medicare coverage Parts A, B, C, and D cover various aspects of health care needs, and each costs a separate fee.

Part A, often referred to as hospital insurance, and Part B, medical insurance, cover many of your health care needs, including hospital stays and doctor visits, respectively. However, they don't include most dental care, eye exams, long-term care, or prescription drugs taken at home.

Part C, also called Medicare Advantage Plan or an MA Plan, is an alternative way to receive your health care. These plans, usually HMOs and PPOs, are offered by Medicare-approved private health insurance companies and include the same services available through Parts A and B along with some additional benefits not covered by Parts A and B. These MA Plans often charge a monthly premium, and have different rules for out-of-pocket expenses than traditional Parts A and B Medicare.

Part D covers prescription drugs. You can enroll in a stand-alone Part D drug program if you're enrolled in Medicare Parts A and B, or receive benefits through an MA Plan that includes drug coverage. Anyone 65 and over is eligible to enroll. Younger adults with certain disabilities can also apply.

What Drugs Are Covered under Medicare Part D?

Medicare Part D covers the prescription drugs that you take at home. There are many prescription drug plan options. Each plan covers different medications and has different co-pays. Generic drugs generally cost less than brand-name drugs. However, all plans must cover the following drug categories:

  • Anticonvulsants
  • Antidepressants
  • Antipsychotics
  • Anti-cancer
  • Immunosuppressant drugs
  • HIV/AIDS drugs

Drugs that are administered in a hospital or outpatient facility such as chemotherapy or dialysis are covered by Medicare Part B, and not Part D. However, some injectable drugs such as insulin fall under Part D.

Drugs that are not covered under Part D include over the counter drugs like ibuprofen or cough syrup, medications used to help grow hair, fertility drugs, or drugs used to help manage your weight. Prescription vitamins, with the exception of prenatal vitamins, are also not covered.

How to Enroll in Medicare Part D

The enrollment period or the period to make changes for Part C and Part D is October 15th through December 7th for coverage starting in January. Joining after that time period may result in a higher or late enrollment fee.

To find the best and most affordable prescription drug plan in your area that covers the drugs you regularly take, consult your Rite Aid Pharmacist or visit the online Rite Aid Medicare Advisor tool.

How Much Does a Part D Program Cost?

Medicare coverage includes part of the cost for everyone who enrolls in a Part D plan. How much you pay above that depends on the plan since plan prices vary. The average Part D monthly premium in 2018 was $34.

Additionally, some plans require an out-of-pocket deductible to be met first before the plan covers all or part of the drug cost. The government sets a limit as to how much a drug plan can set the deductible. In 2018, it was $405. After your deductible has been met, you may pay a co-insurance fee, which is a percentage of the cost of your medication, or a co-pay, which is a flat fee for each medication.

The next cost structuring plan of many prescription drug programs is called a coverage gap, also referred to as a "donut hole." You reach this coverage gap, or fall into the "donut hole" after the total cost of your prescription drugs reaches an amount established by the government (in 2018 it was $3,750). Once you enter this coverage gap, you will pay 35 percent of the total cost of brand-name drugs and 44 percent for generic drugs. After the total cost of your drugs reaches another level (in 2018 it was $5,000), you've "cleared the gap" or "climbed out of the hole," and the price of your drugs goes down.

In 2019, the price you pay for prescription drugs during the coverage gap will go down, and in 2020, it's expected that the gap will close.

If you have any questions about Medicare Part D prescription drug coverage, visit the Rite Aid Medicare Part D information page, or speak with your Rite Aid Pharmacist.

 

Sources:

Medicare.gov, Closing the Coverage Gap

Medicare.gov, Drug coverage (Part D)

AARP, What You Should Know about Medicare Part D

National Council on Aging, How Much Does Medicare Part D Cost?


These articles are not a substitute for medical advice, and are not intended to treat or cure any disease. Advances in medicine may cause this information to become outdated, invalid, or subject to debate. Professional opinions and interpretations of scientific literature may vary. Consult your healthcare professional before making changes to your diet, exercise, or medication regime.