Medicare Part D Benefits

Medicare Part D benefits are available to seniors age 65 and older, to disabled adults and to individuals with end stage renal disease. Many seniors have chosen to take advantage of these federally subsidized benefits to lower the cost of their prescription medications. Medicare Part D covers all or part of the cost of medications that are not covered under Medicare Part A, your hospital insurance, or B, your outpatient coverage.

To receive Medicare Part D benefits, you must enroll in a plan administered by a private insurance company or government organization. You have the option to choose a Prescription Drug Plan, or PDP, or a Medicare Advantage Plan. A PDP plan adds Medicare Part D benefits to your basic Medicare coverage. An Advantage plan, also known as Medicare Part C, wraps the benefits from Parts A, B and D into a single policy, which can make planning your health care easier and more efficient.

Covered Drugs

When you're searching for Part D plans, it's important to understand the Medicare Part D program basics remember that the costs of these policies vary from one provider to another, and from one policy to another. Although the basic prescription drug benefits are subsidized by the federal government, private insurers and other agencies actually administer the coverage. These companies and agencies, which are authorized by the government, may handle Medicare Part D benefits in different ways, at varying costs to the policyholder.

Medicare D covers many of the prescriptions that seniors need to lead fit, healthy and active lives. In order to be covered, a drug must be considered medically necessary, and you must have a prescription for the medication from your doctor. The insurance company that issues your D benefits must authorize the medication before your Part D benefits can apply.

Each insurance company maintains a list of covered drugs called a formulary. In the formulary, you'll find all of the medications included in your benefits. Many companies divide the medications that they cover into tiers based on the cost of the drug. If your doctor prescribes a drug in a high-cost tier, your insurer may not cover the drug until you have tried a similar medication in a lower tier. If you need a prescription in a high-cost tier, your doctor may make arrangements to authorize coverage for the more expensive medication.

Excluded Medications

In order to be covered under your Medicare Part D benefits, a drug must be considered medically necessary. Medications used for cosmetic purposes, such as weight loss drugs or medications for hair loss, and drugs used to treat sexual dysfunction or infertility are not covered. Most vitamin and mineral supplements and over-the-counter treatments are not included in Medicare Part D benefits.

If your doctor feels that you need a medication that is excluded from the formulary, your doctor's office may file an authorization request to have the drug covered. However, these requests can be denied if the doctor cannot prove that a specific drug is medically necessary. Before you buy a policy, review the insurer's formulary carefully to make sure that the medications that you commonly take are covered.

Reducing Prescription Costs

The cost of Medicare Part D benefits depends partly on your income. If your income exceeds a certain threshold, you may pay more for this federally subsidized program than a senior with a lower income. If your income falls below a certain threshold, you may qualify for extra help with Medicare Part D benefits through Social Security. This additional help allows many seniors who could not otherwise afford certain prescriptions to receive the care they need at an affordable cost. Many states also offer programs to help seniors with their pharmaceutical needs.

Choosing generic drugs rather than brand name medications whenever possible is one of the most effective ways to reduce the cost of filling your prescriptions. You can also save money by joining a program to receive your prescriptions by mail. These mail order programs make it easy and convenient to receive your medication on time. By enrolling in a mail order plan, you can save money and time by avoiding extra trips to the pharmacy.

Comparing quotes from several insurance providers will help you find a plan with affordable premiums and co-payments. You may owe co-payments on some of the medications that you buy if they are not fully covered under your policy. As you compare the different policies on the market, check the payment structure carefully to make sure that your financial requirements are clear.

With Medicare Part D benefits, you can lead the healthy, rewarding life you deserve. Seniors need comprehensive, flexible medical treatment to stay fit, active and independent. With a PDP or Advantage plan, you can enjoy a more fulfilling life while cutting the cost of your prescriptions.

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