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What is Medicare Part D?

Medicare Part D is Medicare’s prescription drug benefit that provides outpatient drug coverage. Part D is provided through private insurance companies contracted with the federal government.

If you want Part D coverage, you have to either buy a standalone plan or get it through a Medicare Advantage plan.

Which Drugs are Covered?

Prescription Drug Plans and Medicare Advantage Prescription Drug Plans cover all vaccine drugs when necessary to prevent illness. Other than that, you will have a formulary unique to your plan that details what drugs are covered. So, before you choose a plan, you need to talk to a licensed Medicare specialist like the ones at Brian Scott Insurance to make sure all the drugs you require are covered with your plan.

Which Plans are Available?

Depending on your plan, this answer will differ. However, these are some drugs that will most likely not be covered under any prescription drug plan:

• Weight loss or weight gain drugs

• Any drugs for hair growth

• Fertility drugs

• Drugs for erectile dysfunction

• Any over-the-counter drugs

Also, if your Medicare Part A or B plan is going to foot the bill, Part D does not offer coverage.

You are Notified of Any Changes

You can rest assured that all Medicare Prescription Drug Plans are required to publish any changes to its formulary on the plan’s website. The insurance company must also tell you when drugs are removed from the Part D formulary.

All plans are restricted from making changes to the drugs provided and making price changes between the beginning of the annual election period until 60 days after coverage begins. The only exception is if the FDA determines a drug is unsafe or the manufacturer ceases production of the drug.

Also, any changes must include the name of the drugs removed, if the drug changes tiers, the reason for the change, alternate drugs available, any cost sharing, and exceptions available.

Your Rights to a Prescription Drug Plan

Once you purchase a prescription drug plan, you have the right to:

• Receive a written explanation from your plan about your benefits

• Ask for exceptions if a drug you need is not covered by your plan

• Ask for exceptions to waive coverage rules

• Ask for lower copayments for higher-cost drugs if you or your prescriber believe you can’t take lower-cost drugs for your condition

Brian Penner, CEO

Need Help Deciding?

Let our team of experts guide you in the right direction. We will assess your individual needs and help you select the right plan that fits into your budget.