If you take medication, you’ll have to fit the cost of care into your budget. Given that the costs of drugs without insurance are often very high, you’ll want to see if your own plan will help you out. If you have a Medicare Part D plan, you are in luck in having coverage for your prescriptions. However, the exact costs you will pay might vary. Let’s examine some of these intricacies.
What’s Part D Insurance?
Original Medicare contains two elements—Part A & Part B coverage. Part A will pay for hospital stays, surgeries and similar costs. Part B covers services like doctors’ visits and outpatient care. However, Original coverage will only cover drug treatments in very limited capacities. To have coverage for your standard prescription needs, you’ll likely need Part D coverage.
Medicare Part D is optional, supplementary insurance. Those with Original Medicare can add coverage alongside their existing plan. It will cover some or all the costs of multitudes of prescription drugs.
The Costs of Part D Coverage
Medicare Part D is not a single plan. Different plans exist in different areas. You’ll have options when selecting coverage. You’ll have to compare plans to determine the one with the correct costs to you. What are some of these?
- Premiums: You will pay a cost for the Part D plan itself. You will pay this cost in addition to your Original Medicare premium.
- Deductibles: Some Part D plans include a deductible. Deductibles ranges between $0 and $415 (the highest allowed in 2019). You’ll pay the cost of the deductible before your plan will cover the rest of your prescription costs. However, some plans will not carry a deductible at all.
- Coinsurance/copayments: This is the most common cost Part D plan holders will pay. You will generally pay a small percentage of the total cost for your prescription, or simply pay a set cost (like $5, $10, $15 and so on).
All Medicare Part D plans will contain formularies that list the types of drugs the plans cover. The formulary will usually divide the drugs into different tiers. It is this tier that will influence the copayment or coinsurance you will pay for your coverage.
The tiers a drug enters will depend on things like:
- Whether the drug is name-brand or generic
- The drug’s effectiveness
- The condition the drug treats
You can usually find a plan covering your preferred drugs at a cost that works for you. Keep in mind, however, that if your drug costs exceed a certain spending limit each year, you might enter a portion of coverage called the doughnut hole. During this time, your plan won't pay again until exceed a certain level of personal spending. So, talk to your insurer about whether you can obtain any coverage to insure you during the doughnut hole.
Also Read: Medicare Prescription Drug Formularies