Thinking About Getting Medicare Prescription Drug Plans? You Should Know This First

In 2006, an addition was made to the Medicare program called Medicare Prescription Drugs’ Plan; this is more commonly known as Medicare Plan D now. In case you were already a beneficiary of Medicare when the Prescription drug plans were introduced, but you didn’t avail a Plan D, or you are approaching the age of eligibility for Medicare benefits, it is essential to know more about Plan D health insurance plans. Knowing these things makes sure that you make a more informed decision when getting a prescription drugs plan, so keep reading this article until the end.

What are the eligibility criteria of Plan D affordable health insurance?

In case you are already a beneficiary of Medicare Part A, or you already have Part B of Medicare, you can enroll in Part D and benefit from this affordable health insurance plan. You can get Plan D as part of Part A or B or merge your Part D into your Medicare Part C to get hospital and medical coverage combined with prescription drug insurance. Apart from Medicare plans, some Medicaid beneficiaries are also eligible for Plan D.

Who administers Medicare prescription drug plans?

Even though the federal government’s rules control Medicare prescription drug plans, you get Medicare Plan D through private health insurance companies. You can also get Plan D through health agencies such as The Benefit Link since they are qualified to provide essential information about Plan D.

The private health insurance companies that offer Plan D set the terms and conditions for payments for the Plan they provide and the coverage you get as a result. So, in short, you have to enroll directly with the private insurance company instead of the federal government no matter if you want a stand-alone Plan D or want it as a part of Medicare Plan C.

What is the cost of Medicare prescription drug plans?

The premium cost and deductibles for these insurance plans and the drugs they cover vary depending upon the private insurance company you get the Plan from. With that being said, the average Plan D beneficiary paid a premium of $33.13 every month in 2015. However, if the beneficiary falls in a higher income bracket and those who enroll in the program late can expect to pay higher premiums.

For example, if you register late in Plan D, you can expect to pay 1% in the form of a late enrollment penalty.

What drugs are covered under Plan D?

According to Medicare, a Plan D insurance provider is only bound to provide coverage for two types of drugs: brand drugs or generic medication. So, no matter what disease or condition you have, Plan D might only cover some of the medicines you require and not all of them.

The drugs covered under each Plan are provided in the Plan’s formulary, updated annually during the fall. So if you are taking specific medication that you wish to keep taking, you should stay on top of the formulary updates to make sure it is still a part of your Plan’s coverage. On top of that, you may be met with additional restrictions on the types of medication you can get from your Plan D. Additionally; you may be required to try a cheaper drug first before receiving expensive ones. There might also be higher copayment costs for branded medications.

How much will drugs cost under Plan D?

There are a set of complex rules that govern how much you will pay for medication under Plan D. Normally; you will keep paying 100% of the medication cost until your yearly deductible is reached. Once the deductible limit is reached, you will pay a certain percentage of the medicine price until you get to a “doughnut hole.”

For example, in 2016, a doughnut hole was reached once you spent $3,310 on drugs, and after this limit is reached, the percentage you pay for medication increases. After you spend $4,850; however you get out of the doughnut hole. You are eligible for catastrophic coverage where you pay small copayments throughout the year for your Plan D individual health insurance.