Medicare Drug Plans

7 Facts you Need to Know about Medicare Prescription Drug Plans

Medicare Drug Plans

1. You must have Medicare Part A or B
In order to be eligible for Medicare Part D, you must be enrolled in Medicare Part A or Medicare Part B.

2. There are specific times when you can enroll.
Medicare designates certain times of the year during which you can sign up for Part D. You can enroll when:

    • You turn age 65 during your Initial Enrollment Period
    • Certain open enrollment periods begin
    • You qualify for Special Enrollment Period

3. Check the formulary
A formulary is a list of prescription drugs that a each plan covers. Matching your prescription drug coverage needs with the formulary is crucial when selecting your plan.

4. Higher premiums for higher incomes
When you enroll in a 2011 Medicare Part D or Medicare Advantage Part D plan, if your annual income $85,000 or above or $170,000 combined with your spouse you’ll be subject to a higher monthly premium. Medicare beneficiaries who fit in this category will have the extra cost deducted from their monthly Social Security check regardless of how the premium is usually paid.

5. Some plans have extra requirements.
Different plans will have different rules. Some prescription drug plans will require you to get prior authorization on certain drugs. This means coverage will be offered only after you have proven that a drug is medically necessary. You may also have quantity limits on medication or you may be required to undergo step therapy for certain drugs. Step therapy is when you must first try a lower-priced drug before Medicare will cover the prescribed drug.

4. Savings in the donut hole
As part of the Affordable Care Act, you will now get a 50% discount on approved brand name drugs while in the donut hole or coverage gap. Generic drugs offer a 7% discount. The great advantage to this new savings program is that the full cost of the drug will be factored into your out-pocket-expenses so that your time in the donut hole is not extended. See our previous blog post for more information on how to save.

7. Better late than never, but never late is better
If you don’t enroll in a prescription drug plan when you first become elegible, you will be charged a late enrollment penalty. The later you enroll, the more expensive the penalty.

To get more information about Medicare Supplement Insurance planstalk to one of our Medigap plan representatives today or use our instant quote below.


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