On Medication
Article published in Northampton Living
(July 2023)
EXPERT CONTRIBUTOR
ERICA BEAUDRY
Medicare Advisor
EA Financial Solutions
413 626 9906
info@eafinancialsolutions.com
www.eafinancialsolutions.com
Let's unravel the mysteries of prescription drug coverage for Medicare enrollees and ensure you have all the information you need to access affordable medications.
Medicare offers two primary options for prescription drug coverage: Original Medicare (Part A and Part B) and Medicare Advantage (Part C) plans. Here they are in detail and in brief.
Original Medicare (Part A and Part B)
Original Medicare provides coverage for hospital stays (Part A) and medical services (Part B). However, it doesn't include prescription drug coverage on its own. To bridge this gap, you can enroll in a standalone Prescription Drug Plan (Part D). These plans are offered by private insurance companies approved by Medicare. By enrolling in a Part D plan, you'll gain access to a comprehensive list of covered medications. Each plan has a formulary, which is a list of covered drugs organized by tiers. It's essential to review the formulary to ensure your medications are included and to understand the cost-sharing responsibilities associated with each tier. When selecting a Part D plan, consider factors like monthly premiums, annual deductibles, copayments and coinsurance. You can choose the plan that best fits your needs and budget.
Medicare Advantage (Part C) Plans:
Offered by private insurance companies, Medicare Advantage plans combine the benefits of Original Medicare (Part A and Part B) with additional coverage, such as prescription drug coverage. These plans are an all-in-one alternative to Original Medicare and often include extra benefits like vision, dental and hearing coverage. Medicare Advantage plans with prescription drug coverage, known as MAPDs, provide a convenient way to receive your medical and prescription drug benefits under a single plan. Like standalone Part D plans, MAPDs have formularies with different tiers, so it's important to review the drug coverage details before enrolling into a plan. When considering a Medicare Advantage plan, compare the available options in your area. Look at the premiums, copayments, coinsurance, network of providers and coverage limits. It's crucial to ensure your preferred doctors, specialists and pharmacies are included in the plan's network. Remember, regardless of the option you choose, you must meet certain eligibility criteria to enroll in a prescription drug plan. To be eligible, you need to be a Medicare beneficiary who is entitled to Medicare Part A and/or enrolled in Part B.
To Be Brief
Medicare enrollees have access to prescription drug coverage through Original Medicare with a standalone Part D plan or through Medicare Advantage plans that include prescription drug coverage. Both options offer comprehensive coverage for medications, but it's important to review plan details, formularies and associated costs to make an informed decision. Affordable medications are within reach, ensuring you can maintain your health and well-being without breaking the bank.
Disclaimer: I do not work for and I am not affiliated with Medicare.
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