Drug Coverage

When Original Medicare started in 1965, the American government saw no need for prescription drug coverage, which is why your Medicare card only has Part A (Hospital) and Part B (Medical). It wasn’t until much later that the government realized prescription drug coverage was a necessity. Unfortunately, it would have been too much to change Medicare A and B, as well as Medicare Supplement Plans like F or G, so they created Medicare Part D, a stand-alone prescription drug plan. As a result of this plan, more people could afford their prescription medication, leading to a lower death rate among Americans. Every Medicare Part D plan has a formulary, or a list of covered prescription drugs. If you buy a Part D plan during the 2019 enrollment period, you will only pay a portion of the cost of these drugs, and your plan will cover the remaining balance. Not all drugs are included, so it is essential to review all of the Plan D options before buying any policy.

An essential provision of Medicare Part D plans is the “donut hole,” or coverage gap. Before 2011, after you have received more than the coverage limit of $2,960 in benefits, you were responsible for 100 percent of your prescription costs. After that time, a “Donut Hole Discount” could be applied wherein your plan and the prescription manufacturer pick up some of the cost, even after you meet the coverage limit. Beginning in 2019, your Part D plan will pay 35 percent of the costs, and the drug manufacturer will pay 55 percent, adding up to 90 percent coverage. If you go any further and exceed $4,700 in out-of-pocket expenses, you are protected by the Catastrophic Coverage provision and will be responsible for a 5 percent copay of the formulary drug’s retail price. It should be understood that this provision only applies to prescription medications covered under your plan’s drug list; otherwise you will still have to pay 100 percent of the drug’s cost. There are also benefits and extra help available for those with low incomes, so many of these terms may be flexible depending on the enrollment of each prescription plan.

There are no Medicare Medigap Supplement plans that include prescription drug coverage, but there are about 25 different Part D drug plans available through Medicare. You can pick the Part D plan that is best suited for you and apply it to your new or existing Medigap plan during the enrollment period. The monthly premiums are very reasonable and can be deducted automatically from your social security check.

Upon enrolling in a Medigap plan, you will be contacted by one of our Certified Medicare Part D plan Specialists, who will discuss your prescription needs and help you enter into an appropriate plan. Our plan finders are Medicare, Medigap, Dental, and Part D specialists trained to show you the best options available and work with you to ensure your specific medications are on the plan’s list and your plan is financially viable.