Medicare Advantage Plans

Medicare Part D – Prescription Drug Coverage

Prescription Drug Coverage (Part D) provides coverage for prescription drugs not covered by Original Medicare. Part D plans are offered by private insurance companies. Part D may also be included in some Medicare Advantage Plans.

Medicare Part D

• Must be enrolled in Part A and/or Part B.
• Every plan includes a formulary of covered drugs.
• Each plan will divide drugs into tiers that determine what drugs are available at what copayment cost.
• Exceptions may be requested if your provider determines the need.
• Quantity limits may apply and can restrict the amount of medication purchased at one time. If your provider determines differently, an exemption can be filed.
• Prior authorization may be required for certain medications.
• Step therapy may require trying multiple, less costly, medications for a condition. Exemptions may be filed as determined by your physician.
• Changes annually. Review current drug needs yearly with plan changes to ensure the most cost effective coverage.

Costs of Part D

• Premiums – vary by company and plan. Based on income, there may be additional premiums, please consult your licensed insurance advisor.
• Coinsurance – percentage of the cost of a drug.
• Copayments – cost of prescription drugs in a certain tier.

Enrollment

• Initial Enrollment Period - 7 month period that begins 3 months before turning 65, birth month and 3 months after.
• Late Penalties- there may be penalties if enrollment is delayed. In order to avoid penalties, enroll during your initial Enrollment Period or maintain creditable coverage. Creditable coverage is other prescription drug coverage that could be provided through an employer or other health insurance provider that meets certain predetermined standards. Consult your licensed insurance advisor for current information.