Medicare Prescription Coverage for Seniors
Prescription CoveragePart D of Medicare or the prescription drug coverage is a program created to subsidize the costs of prescription drugs for the beneficiaries of Medicare in the United States. The program was created as a section of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, which was established in January of 2006.
The prescription coverage can cover both generic and brand-name prescription drugs at involved pharmacies at specific areas. The programs provides protection for those who have very high cost of drugs or others that might have unexpected prescription drug bills in the future.
The Medicare prescription drug coverage can cover those who are eligible for the programs, regardless of their resources or income, current prescription expenses and health status.
The Enrollment Period
The enrollment for the program is completely voluntary. However, the first enrollment period started from November of 2005 to May of 2006. Those who were not able to enroll themselves to the program acquired a late enrollment penalty of 1% each month based on the average cost of the premium until their enrollment.
Yearly enrollment periods for the programs start on the 15th of November of the prior plan year. More so, the initial period of enrollment for the second year of the Medicare prescription coverage began on November 2006. During its initial year, the beneficiaries eligible for Medicare and Medicaid were moved from Medicaid prescription coverage to Part D of Medicare on January 2006.
Recently, there are 1,824 Part D plans available and these plans are stand-alone. The available plans also vary by number and region, with 27 as the lowest found in Alaska and 63 as the highest in Pennsylvania and West Virginia. This kind of system allows beneficiaries to choose a plan the best suits their needs. Plans they choose can cover diverse kind of drugs at various co-pays. Additionally, they can also opt not to cover some drugs at all.
The Formularies
Plans of Part D are not obligated to pay for all the drugs covered by Part D. They create their own formularies or a roster of drugs covered by the programs for which they can make the payment. However, the formulary and the structure of the benefit must not be found by the CMS to cause discouragement in the enrollment of certain Medicare beneficiaries.
Those plans that follow formulary categories established by the United States Pharmacopoeia must first pass the discrimination test. The Plans can also change the drugs on their formulary over the course of a full year with sixty days notice to the involved parties.
In general, the formulary of the plans is organized into tiers and each tier is associated with a set co-pay amount. Often, most of the formularies have 3 to 5 tiers.
The Drugs Excluded
The CMS does not have an established formulary and the Part D drug coverage excludes those drugs that are not accepted by the Food and Drug Administration. In addition, drugs that are not available by prescription purchase in the United States, not for use in their medically established suggestion and those drugs for which payments would be available under Parts A and B of Medicare are also excluded.
Excluded drugs from the Part D coverage may include drugs that are used for weight loss or gain, and anorexia, drugs used for erectile dysfunction, drugs that are used to promote fertility, drugs used for the symptomatic relief of colds and cough, and drugs that are used for cosmetic purposes. Barbiturates, prescription vitamins and minerals, and benzodiazepines are also excluded.
The Things You Should Consider
In order to obtain Medicare coverage for the prescription drugs you use, you must first choose and join a drug plan. In spite of how a drug plan decides to offer this kind of coverage, there are some important key elements that can vary.
Some of the factors that might be important to you than others include the cost, convenience, and coverage. Costs for the drug plan are available in three categories, namely premium, deductible, and the co-payment or co-insurance.
As for the coverage, you must decide what formulary you can use, the prior authorization and the coverage gap. Also, the drug plans must be contracted with the pharmacies in your local area in order to provide convenience.
