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What Drugs Are Covered Under Medicare Part D Insurance Plans?

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Many people rely on prescription drugs for their well-being, such as heart medications and psychiatric prescriptions. Being forced to go off these medications could lead to life-altering situations. And patients have valid concerns about the extent of their prescription coverage. But once you’re age 65 and eligible for Parts A and B, you need to find out more about drug coverage under Medicare Part D.

medicare part dLegitimate Medications Matter

Failure to find the right coverage puts patients in a desperate situation. Some order online from fly-by-night companies. And others use medication from friends or family with similar health conditions. Plus, some patients leave the state or country to buy meditations.

However, none of these drugs is reliable and safe. As a result, patients can get injured or die from using them. Never take risks with your prescription drugs. Policy choices exist once you’re Medicare eligible that will help you cover the cost of your medications.

Medications Become Costly

Another issue for people who depend on medication is the rising cost of certain prescription drugs. And for older people on a fixed income, these costs can be difficult to cover. The price could mean choosing between buying monthly prescriptions or putting food on the table. An insurance agent helps people facing this type of crisis. And it takes searching to find the right Medicare Part D coverage. But supplemental plans are available to get the highest level of coverage.

Medicare Drug Plans Are Different

Some people believe all Medicare drug plans provide the same coverage. But there are different options, and each has its unique benefits. Working with a licensed insurance agent can reduce the confusion. An experienced pro knows to help people find the right plan for their individualized needs.

Plans vary in what they cover year in and year out. You should almost always check your options every year during the Annual Election Period (AEP) which runs from October 15th through December 7th. For most consumers, this is the only time they can change drug plans. Changing plans can reduce premiums, lower or eliminate copays, and avoid annual deductibles. Those who haven’t shopped their Part D drug plan for several years could be overpaying by several hundred dollars.

It’s also very important to make sure you’re using a in-network pharmacy. Almost all Part D drug plans offer better prices at their preferred pharmacy where they have negotiated lower rates. One of the biggest (and most easily correctable) mistake Medicare beneficiaries make is buying their drugs from an out-of-network or non-preferred pharmacy. Consumers should always make sure they are using the best pharmacy – either by mail order or in-person.

Find Out About a Formulary

Each Medicare plan provides a specific list of covered drugs. And this list is called a formulary. In most of these lists, drugs appear in different tiers. And the drugs in each one have various costs. For example, a drug on a lower tier is likely to cost less than one put in a higher one.

Some drugs can be in one tier one year and then a higher tier the next. This results in higher copays and/or needless exposure to deductibles. A good agent can tell you where you are leaving money on the table. This savings can help many to stay with the prescriptions that give them the best results.

Working With Prescribers

When a patient discovers they must take a drug on a higher tier, the cost can be more than expected. But there are ways to reduce this cost potentially. Discuss your needs with a doctor or prescriber. While they might believe you need a drug on a higher tier, there could be a reasonable substitute.

For many, generic drugs are also a viable option. Find out if a different medication is a possible solution. Many consumers come on to Medicare only to realize that name brand drugs are very costly where a generic substitute can offer the same efficacy at a fraction of the cost.

And you should also know that some drugs fall under Medicare Part B. These are drugs that are administered at a doctor’s office – usually they are injections or administered intravenously. This means that Medicare and your supplemental insurance will cover the cost. This is why it’s a good idea to have a comprehensive Medicare supplement along with your chosen drug plan.

Necessary Drugs

In certain situations, there might not be a substitute for a high-cost prescription. However, you or your prescriber can ask your Medicare Part D provider for a tier exception. The result would be a lower copayment for the patient. Often this is the best way for people to cover the costs of medications they need to maintain good health.

There are several ways to reduce the costs of expensive medications by working with your doctor, your Medicare plan provider, the drug manufacturer and the State where you live. There are several programs designed for those who fall in certain income levels.

Changes To the Medicare Formulary

Sometimes a Medicare drug plan makes changes to its formulary throughout the year. Changes occur within the guidelines established by Medicare. However, if the change involves a drug you are taking, the plan must follow specific steps.

First, they must send written notice of the change to you within 60 days before the change become effective. Next, when you request a refill, a notice of the change must be issued with a 60-day supply of the drug under the same plan rules that existed before the change. If you encounter this issue, then it’s a good idea to work with your doctor to see what other options might be available.

How To Get the Coverage You Need

Consult with your insurance agent about changes. Work each year to review the formularies of Medicare Part D plans to find one that offers the best prices. Contact your doctors and prescribers to find out more about alternatives. With some work, patients can get the coverage they need to get the right prescription drugs.

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Category: Medicare Part D