
What Are Medicare Excess Charges?
Medicare excess charges are one of those complicated Medicare topics which tends to raise questions for potential Medicare Supplement plan enrollees. Read on to find out what you
In need of personalized Medicare advice? Get free guidance today.
In need of personalized Medicare advice? Get free guidance today.
In need of personalized Medicare advice? Get free guidance today.
In need of personalized Medicare advice? Get free guidance today.
In need of personalized Medicare advice? Get free guidance today.
Medicare excess charges are one of those complicated Medicare topics which tends to raise questions for potential Medicare Supplement plan enrollees. Read on to find out what you
In need of personalized Medicare advice? Get free guidance today.
In need of personalized Medicare advice? Get free guidance today.
Medicare Part D is the facet of Medicare that covers prescription drug benefits. Enrolling in a Part D plan can help to lower your medication-related expenses.
Medicare Part D plans cover a variety of prescription medications, both generic and brand-name. Which specific medications are covered by each plan are detailed in the plan’s formulary, or drug list. Drug formularies usually include at least two different medications in each category of commonly prescribed drugs.
If your specific medication isn’t included in your plan’s formulary, you will probably be able to find a similar drug to substitute it. If you or your health care provider considers that your plan offers no appropriate drug to replace it, you can request an exception. In this case, your plan may agree to cover your medication.
Medicare drug plans are allowed to change their drug lists over the course of the year if drug treatments change, new drugs become available, or new medical information is released. Therefore, you should always stay up-to-date on your plan’s drug list.
There are also medications that Part D drug plans are not required to cover. These include weight loss/gain medications, erectile dysfunction medications, and over-the-counter drugs. However, some plans may choose to cover some or all of these medications.
Medicare drug plans are required to cover all drugs within certain “protected” classes. These drugs include:
If you have to take any of the drugs mentioned above, you can be assured that your Medicare drug plan will include coverage for them.
Drug plan formularies are divided according to drug tiers. Most plans organize their drug tiers in the following manner, though some plans may have different guidelines for setting their drug tiers:
In general, the higher the tier, the higher the copayment/coinsurance you will be responsible for paying.
If you are prescribed a drug in a higher tier and you and your physician consider that you need that specific drug instead of a similar drug in a lower tier, you may request an exception. This would allow you to pay a lower coinsurance or copayment for the drug in the higher tier.
First, you can purchase a “stand-alone” drug plan that only offers prescription drug coverage. These plans are available for people enrolled in Original Medicare, and you must sign up through a private insurance company.
Each state offers its own unique drug plans, and it is important to do your research in order to find which one is the best option for you.
You also have the option to enroll in a Medicare Advantage plan that includes drug coverage. Many Medicare Advantage plans include drug coverage, but not all of them, so be sure to enroll in a plan that does if you would like those benefits.
It is important to note that if you enroll in an HMO or PPO plan that doesn’t offer drug coverage, you are not allowed to enroll in a separate Medicare drug plan.
There are four stages of Medicare Part D coverage that affect how much you need to spend out-of-pocket on your medications over the course of the year:
Once the calendar year ends, your Medicare Part D status resets and you return to the initial deductible stage. It is also important to keep in mind that you will be responsible for paying a Part D monthly premium for your Medicare drug coverage.
As we mentioned, you cannot sign up for Medicare Part D in the same way that you enroll in Medicare Part A and B. You must either sign up for a “stand-alone” drug plan or enroll in a Medicare Advantage plan that offers drug coverage.
A licensed insurance agent here at Medicare Plans Direct can help you find the Medicare Part D drug plan that is right for you. Don’t hesitate to get in contact with us if you are seeking Medicare advice.
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