The ongoing cost of medications for American seniors can cripple your budget if you’re not covered. According to a recent article on Bloomberg, American’s spend more on prescription drugs than any other nation in the world. While it’s true that we consume a lot of medicine, what really sets the country apart is cost.
In recent years we have witnessed an upsurge in the price of Insulin, HIV treatment, and more. Cancer drugs alone routinely cost around $10,000 a month. In the big pharma market, companies can boost costs because they face little to no competition.
If you or your loved ones are dealing with a condition that requires prescription medication, your primary concern is finding coverage. In this article, we’ll review the options that are available for people over 65.
Medicare Prescription Drug Plan
Medicare Prescription Drug Plans (Part D) are only offered by insurance companies and can be purchased as a stand-alone plan. This coverage option, otherwise known as PDPs, provides a smart way to manage the costs of your current and future medications.
If you’re entitled to Part A, Part B, or both of Original Medicare, then you’re also eligible to join a Part D plan. These plans can add coverage to Medicare Private Fee-for-Service (PFFS) and Medicare Medical Savings Account Plan (MSAs). They may also apply to Medicare Cost Plans.
Medicare Part D coverage is available through private insurers that are contracted by Medicare. The costs and availability can vary.
It’s important to note that when you enrol affects the effective date as well as your premium. If you don’t sign-up when you’re first eligible, you could face a late-enrollment penalty when you sign up later on. The penalty will come in the form of a higher premium, and you may have to pay at this level permanently.
Medicare Advantage Plan
Part C, the Medicare Advantage Plan is another option available to you for prescription drug coverage. This plan is like an HMO or PPO. Plan C, as well as other Medicare health plans, is added to your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.
The Medicare Advantage Plan is ideal for people who enjoy the lower costs and added benefits of having one comprehensive plan. There’s convenience in getting health care and prescription drug coverage from one policy. However, you should be willing to accept that this drug plan will have restrictions on doctors, hospitals, and other providers that you might visit.
Compare Your Choices
Before you decide on prescription drug coverage, make sure that you compare your choices. For example, many individuals already have coverage from an employer, union, TRICARE, VA, Indian Health Services, or Medicare Supplement Insurance.
If you’re eligible for another type of drug coverage, make sure you read all of the materials available to you. Ask your insurer or plan provider and discuss what will change if you opt-into a Medicare prescription drug plan.
Important Considerations
It can be challenging to decide on the best drug plan to suit you. The best way to start is to analyze your priorities. Look at the plans that include your specific medications. You can see this on the plan’s formulary, which is a list of prescription drugs that are covered.
If you need extra protection from high prescription costs, then look at each plan in detail and make sure that they cover your drugs in the gap. Try to find plans with little to no deductible, so your expenses will be more balanced throughout the year.
Some Medicare drug plans incorporate “tiers.” These plans cost you low or no copayments for generic prescriptions. Each prescription drug plan differs in terms of what specific medications are covered in their formulary.
If you fill out a prescription that isn’t in the formulary, you may be responsible for its full cost. If your Medicare PDP or Advantage Prescription drug plan doesn’t cover a medicine that a doctor recommended for you, you have the right to ask for an exemption to get it covered. To do this, you must submit a request over the phone or in writing.
Many people seeking coverage do so to be prepared for the future. While you may not have any drug costs now, you’ll want coverage and peace of mind. This is a responsible decision, mainly because you’ll avoid future financial penalties. If you’re one of these individuals, seek out Medicare Drug Plans that have low monthly premiums.
To Conclude
Private health insurance policies cover the cost of prescription drugs, but those who have state-sponsored healthcare may have to pay out-of-pocket. Medicare prescription drug coverage is an optional benefit for anyone covered by Medicare. If you decide not to get it when you sign up, you’ll likely pay a late fee in the future.
When deciding on a Medicare prescription drug plan, it’s essential that you analyze your current medical situation and any coverage you may receive from other sources. Speak to your benefits administrator, insurer, or plan provider before making any changes to your existing policy.
