What is Medicare Prescription Drug Coverage?

Starting January, 1, 2006 Medicare prescription drug coverage became available to everyone on Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare prescription drug coverage is insurance. Private companies provide the coverage. You choose the drug plan and pay a monthly premium. Like other insurance, if you decide not to enroll in the drug plan when you are first eligible, you may pay a penalty if you choose to join later.

What to remember when you are making a Medicare Part D decision.

Coverage – Medicare drug plans will cover generic and name brand drugs. Plans may have rules about what drugs are covered in different drug categories. These are also known as “tiers”. This makes sure that people with different medical conditions can get the treatment they need. 
Most plans have a formulary, which is a list if drugs covered by the plan. This list must always meet Medicare’s requirements, but it can change when plan’s get new information. Your plan must let you know at least 60 days before a drug you use is removed from the list or if the costs are changing.

If your doctor thinks you need a drug that isn’t on the list, or if one of your drugs is being removed from the list, you or your doctor can apply for an exception or appeal the decision.

Cost – Monthly premiums and your share of the cost of your prescriptions will depending on what plan you choose.

Convenience – Drug plans must contract with pharmacies in your area. Check with the plan to make sure the pharmacies in the plan are convenient to you. Some plans also allow you to order prescriptions through the mail.

Security Now and In the Future – even if you don’t take a lot of prescription drugs now, you still should consider joining a drug plan. As we age most people need prescription drugs to stay healthy. The enrollment period for Medicare Part D begins each year on October 15th and goes through December 7th. If you sign up for a plan, your benefits begin January 1st.
If you delay signing up for a drug plan, your premium cost will go up at least 1% per month for every month that you delay. Like other insurance, you will have to pay this penalty as long as you have Medicare prescription drug coverage.

Please allow us to help you make an informed decision. Currently we work with many Part D carriers. We will provide a free analysis using the medication you currently take. Please feel free to call us with questions, or take a moment to fill out an inquiry form and a licensed specialist will get back to you.

Some of the Companies We Represent:

  • Blue Medicare RX 
  • Advantra RX 
  • UnitedHealth RX
  • Aetna
  • Humana RX



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