Basics on the Medicare Prescription Drug Plan

Insurance to Keep You Financially and Physically Healthy

As you become eligible for Medicare, you will probably find yourself also considering buying additional insurance to cover the costs of prescription drugs. In fact, you will discover that Medicare strongly urges you to buy supplemental coverage, because prescriptions are not included in basic Medicare coverage.

The additional coverage is important because medication costs are already very high and are likely to go up. You don't want to be caught in a situation where you can't afford medication that you need. In fact, Medicare believes this additional insurance is so important that it will financially help those people who cannot afford a prescription program on their own.

Prescription Drug Programs

Medicare prescription drug plans are available on a state-by-state basis. (You cannot buy insurance from a provider outside your state.) These plans are provided by private insurers who are pre-approved by Medicare. Generally, prescription drug programs are known as Medicare Parts C and D. Medicare Part C is also known as Medicare Advantage. This insurance offers additional coverage for vision and dental, as well as prescriptions. A Medicare Part D insurance plan covers only prescriptions.

Terms of the Coverage

Different plans offer different levels of coverage: the higher the premium, the greater the coverage. But price is not all you will want to consider. Remember that plans do not cover all drugs or the same drugs. One complaint about prescription plans is that insurers can drop a medication from its plan that was covered the previous year.

Each plan has a monthly premium and a deductible that needs to be fulfilled before the coverage kicks in. The co-pays for drugs are based on a tier structure. Generic medications require a lesser co-pay than other, newer drugs that can have a much higher co-pay. Drugs listed as Tier 1 can cost a few dollars in co-pay. Drugs listed as Tier 2 will have a higher co-pay. Drugs listed under Tier 3 would have the highest co-pay. Not all plans cover the same drugs, nor place them in the same tiers, nor charge the same co-pays. In assessing a plan, you will want to carefully apply your medication needs against its coverage to see if it is right for your needs. Nothing is wrong with comparing and contrasting plans with a variety of insurers.

Another complaint about prescription drug plans is the ceiling of coverage. Many plans will cover a consumer up to a certain amount of dollars. If that amount is reached, the consumer has to pay for all medications at full price and out of pocket. If this full price, out-of-pocket amount reaches another prescribed ceiling, the drug coverage kicks in again, in what is known as catastrophic coverage. For people who require a lot of medication, a plan that offers no ceiling or a high ceiling might work for them, although it might cost more in premiums. This is an example of how someone might assess a prescription drug plan.

Timing Is Important

Timing is important, too. When considering supplemental insurance for medications, remember that you need to enroll by December 31 of the year you begin Medicare. Otherwise, you have to wait a full year to enroll. Even if you consider yourself very healthy, it's a fact that the older we get, the higher the likelihood we will need some kind of medication. You wouldn't want to be stuck in a situation where you need medication and have no coverage.

Who Accepts Your Supplemental Prescription Plan

As well as considering what you want from a plan, you will probably want to consider who accepts this insurance. Of course, you want it to be accepted by a pharmacy near your home and with your doctor's office and local hospital. Most pharmacies and doctors have a list of accepted plans readily available to patients and customers. All you need to do is ask.

Yes, There Is a Lot of Homework

Choosing a prescription drug program can drive some people to distraction, but on the positive side, it's a way of taking control of your physical and financial health. And that's something to feel good about. Give yourself the time necessary to go over the plans and your health needs. Use state, federal and local resources if you have questions. Do not be afraid to ask questions of your primary health care provider or pharmacist.

Having Peace of Mind

Supplemental coverage can actually give you peace of mind--it's there if you need it and when you need it. It may seem like a lot of work but many seniors believe it's well worth the effort.

SunTrust is unable to offer tax or legal advice. Please consult with your tax and legal advisors.