Does Medicare Have Coverage for Prescription Drugs?
*Updated for 2010*
Yes, Prescription drugs are covered under Part D of Medicare. People who have Medicare Part A or Part B are eligible for Medicare prescription drug coverage. They can enroll in any of the Part D plans that serve the area where they live.
The annual enrollment period for Part D is from November 15 to December 31. During that time period anyone with Medicare can enroll in a plan or change from one plan to another. There are some important things to keep in mind when it comes to prescription drug coverage:
- It is very complex, can be confusing and is changing on a regular basis. You will have to make decisions to get the plan that is right for you and covers the drugs you need.
- You can get help making decisions through our office (888-484-0414) and/or combining your Medical Part B and Drug Part D in a Medicare Advantage Plan (HMO, PPO).
- You do not have to take Part D coverage. That decision will not affect the other coverage you have. A good thing to remember is you will have to pay a higher premium if you choose to enroll later, unless you can show Medicare you had drug coverage at least as good as theirs during the time you were not enrolled in Part D. This is known as creditable coverage.
- When choosing a Medicare Part D plan, ask good questions and do your homework.
Things you should ask:
Can I buy Part D drug coverage without having my Medicare replaced by an HMO product or Medicare Advantage Plan?
How Can I Delay Reaching the Coverage Gap?
There are a number of things you can do to help reduce your drug costs, they include:
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Switching to lower cost drugs: Talk to your doctor about using generic and/or over-the-counter (OTC) drugs. Many work as well as the higher cost prescriptions. It can help you save hundreds of dollars a year and can be just enough to keep you out of the coverage gap.
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Take advantage of mail-order programs: They can save you many dollars a year on medication used long term (90 days or longer).
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When you use your Medicare drug plan card at a pharmacy, any money you spend on drugs is automatically counted towards your deductible.
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If you do not have a deductible, or want to delay reaching your coverage gap after meeting your deductible, you may want to utilize a local retail pharmacy who offers a Generic Drug Program. Some pharmacies that offer such a program are: Walmart, Target, Rite Aid, CVS, and Stop & Shop. These programs allow you to purchase 30 day supplies of commonly prescribed generic medications for as low as $4 for a one month supply and as low as $10 for a 90 day supply. Some pharmacy's programs do not require to use your Drug ID card so as a result, this will delay your reacing your coverage gap. (check with each pharmacy to see their rates and conditions. Drug lists are subject to change, please check with pharmcay before purchase. Membership may be required).
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Look for programs that offer assistance: Programs, such as the National Patient Advocate Foundation or the National Organization for Rare Disorders, may have programs that can help with your drug costs. Comprehensive information on federal, state and private assistance programs in your area is available at www.benefitscheckup.org.
Is There Help for People Who Have a Low Income?
The program is called Low-income Subsidy (LIS) Program. If you have a low income you may have been automatically enrolled in a program (this may vary state to state). If you have not been automatically enrolled in the program you may still qualify for it. The program helps you pay for your Medicare prescription drug costs, including premiums, deductibles and co-payments. To qualify, you must meet the following criteria:
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You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
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You live in one of the 50 states or the District of Columbia; and
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Your yearly income (in 2009) below $16,245 ($21,855 for a married person living with a spouse and no other dependents) and resources (in 2009) less than $12,510 ($25,010 for a married person living with a spouse and no other dependents).
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There is an exception: Even if you meet these conditions, you will not qualify if any of the following apply:
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You receive Supplemental Security Income (SSI) payments and have Medicare;
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You receive Medicaid and have Medicare; or
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Your state pays your Medicare premiums
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To see if you qualify please visit: http://www.socialsecurity.gov/prescriptionhelp/
What Does Part D Cost?
In addition to your monthly premium your costs for Part D coverage are:
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An initial $310 deductible.
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After meeting the deductible the beneficiaries pay 25 percent of the cost of covered prescription drugs, up to $2,830.
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Once the prescription drug costs are reached, you are subject to another deductible, known as The Coverage Gap, in which you must pay the full costs of drugs until a total out-of-pocket expenses of $4,550 is reached (this includes the costs of the deductible and coinsurance).
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Once you have reached the out-of-pocket costs, you qualify for Catastrophic Coverage" and will pay $2.50 for a generic drug and $6.30 for other drugs, or a flat 5 percent co-insurance, whichever is greater.
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An important thing to keep in mind is the $4,550 out-of-pocket threshold is an annual deduction that you will have to pay each year. You should expect those costs to increase each year.
What Kinds of Things Should I Consider When Choosing a Plan?
When reviewing prescription drug information, consider how much the plan will cost. There are a number of factors to look at when it comes to costs:
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Premium: This is the monthly cost you will pay once you have signed up with the plan. Premiums vary by plan.
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Deductible: This is the amount you pay for your prescriptions before your plan starts to share in the costs. Deductibles vary by plans. Some plan do not have deductibles; However, plans cannot charge more than $310 dollar for the yearly deductible.
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Copayment/Coinsurance: This is the amount you pay each time you buy a prescription. This can be very different from plan to plan. For example, in some plans you pay the same amount for any prescription while other costs will depend on the brand of drug and whether or not the drug is a generic or brand name drug. Also, in some plans your share of the cost may go up when you pass an annual spending limit for drugs.
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Medicare Part D>>