By now, you've probably heard about the Medicare Part D prescription drug benefit. Perhaps you have questions about how the program works and whether to sign up. Medicare beneficiaries should consider the following in their Part D decision-making process:
Q: Am I required to participate in a Part D plan?
A: No. You decide whether you wish to participate in Medicare Part D or not. You may want to compare Part D plans to other options you may have for prescription drug coverage.
Q: Does the plan cover the prescription medications that I use?
A: Part D prescription drug plans will vary as to which specific medications they will cover. Generally, plans are required to cover one drug out of each class of medication available - which means that it may be acceptable for a plan to choose to cover Glucophage but not Glucophage XR, for example. Each Part D plan will have a formulary - a list of medications that it will cover. Before signing up for a plan, be sure to check that the plan formulary includes the medications you take. It is best to contact the administrator of the plan you are interested in directly to confirm that your medications are included on the formulary.
Q: How much of each prescription will be covered under the plan?
A: Part D plans are allowed to use “tiering” systems to cover different medications at different rates. For example, a plan may decide to cover 75% of the total cost of Humalog, but only 50% of the total cost of Avandia. Another plan may decide to cover 95% of each. Before signing up for a plan, find out what your out-of-pocket costs for each medication will be. Contact the administrator of the plan you are interested in directly to find out exactly what the plan will pay for.
