3 Things You Need to Know About Medicare Prescription Coverage

3 Things You Need to Know About Medicare Prescription Coverage

Dec 05 2016

If you’re contemplating your Medicare options, one of your biggest concerns is likely the cost and coverage of prescription drugs.

As you age, your doctor may prescribe more medications to help you manage your health. And with rising drug prices, it’s understandable that prescription coverage tops the list of considerations for many people while exploring Medicare options.

When it comes to Medicare, you have two choices for prescription drug coverage – a stand-alone Part D plan or a Medicare Advantage Prescription Drug plan that includes drug coverage.

Here are three tips to help guide your decision-making process:

Decide what kind of plan you want

As with any medical coverage, it is important to consider your personal health needs and preferences when making a decision about prescription drug coverage. If you want to have all of your medical coverage and prescription coverage provided by a single company, a good option might be a Medicare Advantage Prescription Drug plan that is offered by a private insurer. If you choose to use Original Medicare or opt for a Medigap (Medicare Supplement) plan, you will not have prescription drug coverage so you’d need to shop for a Part D plan separately. Employer or union coverage also affects prescription drug coverage, so make sure to check with your benefits administrator.

There are many choices when it comes to Medicare Advantage Prescription Drug and Part D plans. While it is important to consider potential premiums, copays and accessibility of pharmacies for a specific plan, you’ll also want to look at the company providing you the coverage. Does the company focus on quality? What is their customer service like? Will the company offer you extra services and tools to help you stay healthy and take more control of your health? Thinking about the entire package will help you make a decision you can feel good about.

This video helps explain what kind of coverage you can get with Medicare Parts C (Medicare Advantage), D (prescription coverage) and Medigap.

Know the Timeline

As you approach your 65th birthday, you will be entering the Initial Enrollment Period for Medicare coverage — a 7 month period surrounding your birthday —  the three months before and the three months after your birthday month.

After your Initial Enrollment Period, you can only join, drop or switch Medicare Advantage Prescription Drug or Part D plans during the Annual Enrollment Period, which occurs annually between Oct. 15 and Dec. 7. There are underlying circumstances where you can switch outside of the Annual Enrollment Period, such as if you move out of your plan’s service area, lose your creditable prescription drug coverage or qualify for a subsidy because of limited income or resources. These scenarios would qualify you for a Special Enrollment Period.

Avoid the late enrollment penalty

If you are relatively healthy and currently not taking medications, you may consider forgoing prescription coverage. Instead, you should still consider purchasing prescription drug coverage because if you don’t have ‘creditable coverage,’ and don’t enroll in Part D when you’re eligible, you’ll need to pay a late enrollment penalty when you do decide to enroll. Creditable coverage is prescription coverage that is as good as Part D Medicare or better. You might have coverage from an employer or union that counts as creditable coverage.

How long you didn’t have creditable coverage will affect how much your late enrollment penalty amount will be. It will be added onto your Part D premium for as long as you have the plan.

These tips can help you determine what prescription drug coverage is right for you when it comes to Medicare. If you have trouble paying for your prescription coverage, you may be eligible for a subsidy called Extra Help. With Extra Help, you’ll get assistance paying your Part D or Medicare Advantage Prescription Drug plan monthly premium, annual deductible, coinsurance or copayments. You won’t have a coverage gap, late enrollment penalty and will also be able to switch plans at any time. For more information, contact the Social Security office at 800.772.1213 or visit socialsecurity.gov.

Choosing the right Medicare plan depends on your specific situation. Fortunately, there are many resources available to beneficiaries. To speak with someone about your options, call Priority Health at 866.562.5851 and download Priority Health’s Medicare guide below for additional information.

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