Prescription medications can be an important part of your health care routine. Medicare Part D helps cover prescription drugs, but coverage and costs can vary from one plan to another.
How do you get Part D coverage?
There are generally two ways to receive Medicare prescription drug coverage:
- Enroll in a stand-alone Part D plan if you have Original Medicare.
- Enroll in a Medicare Advantage plan that includes prescription drug coverage.
You must have an eligible enrollment period to join or change a plan.
What is a formulary?
A formulary is a plan’s list of covered medications. Plans may group medications into different tiers, and each tier can have a different cost.
Before choosing a plan, check every medication you take, including the dosage. A plan’s coverage may also include requirements such as prior authorization, quantity limits, or step therapy.
Why does your pharmacy matter?
Part D plans use pharmacy networks. Your costs may differ depending on whether you use a preferred pharmacy, another in-network pharmacy, or a mail-order option.
What costs should you consider?
Depending on the plan and your prescriptions, you may pay a monthly premium, deductible, copayments, or coinsurance. Medicare also has an annual out-of-pocket limit for covered Part D drugs; the amount can change from year to year.
The Medicare Prescription Payment Plan gives eligible participants the option to spread covered out-of-pocket drug costs over the year. It does not reduce the amount owed.
Review your coverage regularly
Your medications and plan details can change. Reviewing your coverage when you have an opportunity can help you understand whether your current plan still meets your needs.
Bring your medication list to your next review. Our office can help you compare the prescription drug options available to you. Call us at (210) 744-0553 to schedule an appointment!