Choosing a healthcare coverage plan can be complicated. Understanding what’s included and what isn’t can be overwhelming, especially for those making the transition to Medicare.
Prescription medication sts are of particular concern, especially with healthcare costs on the rise. Here’s everything you need to know about Medicare coverage and how to include prescription medications into your healthcare plan.
Medicare Coverage 101
Before you can figure out medication coverage, you need to have a basic understanding of how Medicare works. Mostly, there are four components of the program, labeled Parts A, B, C, and D.
Parts A and B are the main components of Medicare. They cover inpatient and outpatient services, such as wellness checkups, diagnostics, ambulatory care, and trips to the hospital. When you sign up for Medicare, it only comes with Plan A and B unless otherwise specified.
Part C is called Medicare Advantage. Medicare Advantage comprises of Parts A and B but is offered through a private company. Depending on your provider, Part C could limit your network options and may include medication coverage. Part C often comes at a higher expense than original Medicare.
Finally, you have Part D. Part D is an add on to Original Medicare that covers prescription medications. If you don’t use Medicare Advantage, adding on Part D is the only way to get medication coverage in Medicare.
How to Include Prescription Medication Coverage
Choosing whether to get Part D as an add on to Original Medicare or using Medicare Advantage to have it included, is much dependent on your needs and budget. To ensure you have proper coverage, you’ll need to learn about Medicare prescription medication plan options and enroll in Part D when you sign up for Medicare during the enrollment period – find out everything about this on the HealthMarkets Medicare part D page. Failure to do so could result in coverage gaps or penalties.
The Initial Enrollment Period (IEP) when you can start using Medicare is in the seven months surrounding your 65th birthday. In other words, the three months leading, the month of, and the three months following your 65th.
The Fall Open Enrollment Period (FOEP) is when you can change your plan. This period takes place from October 15th to December 7th. If you missed adding Plan D to your Original Medicare, this is the time to add it.
Understanding the Donut Hole
Part D is a form of supplemental health coverage. Even though it’s a high-value add-on to Medicare, it isn’t without flaws. The gaps left in coverage by Part D are often referred to as the “Donut Hole.”
If you never meet the threshold of your plan, you won’t have to worry about falling into the Donut Hole. For Part D, if you exceed the threshold, you end up being responsible for a higher percentage of your prescription medication costs. This number changes each year. In 2018, the limit was $3,750, and in 2019, the amount is $3,820. For 2023, it’s expected to start closing.
On the other side of the gap is what’s known as “Catastrophic Coverage,” which is where your plan kicks back in. The Catastrophic Coverage threshold was $5000 and $5100 in 2018 Medicare and 2019, respectively.
Tips for Saving on Prescription Medications
The best way to avoid going into the donut hole and cutting back on your expenses is to be proactive in saving on prescription medications. Here are some helpful tips for saving:
- Shop around – some pharmacies charge less on dispensary fees than others.
- Bulk your prescriptions – dispensary fees are a flat rate charge. If you can get a bulk supply of your prescription medication at once, you’ll save on dispensary fees.
- Go generic – using generic alternatives to brand name medications is an effective way to reduce your expenses.
By taking the time to understand prescription medication coverage, you can find the plan that works for you.