Medicare Prescription Coverage ( Medicare Part A, B and Part D) 

Most Medicare prescription drugs will be covered under Medicare Part D coverage. These can be Medicare Part D coverage drugs that are prescribed by a health care provider and purchased at a pharmacy, or an online distributor. Even though, some medications can be covered under Medicare Part A (Hospitalization) and Medicare Part B (Medical). 

•  Part A covered drugs: These are drugs that you receive while you have a Medicare covered stay in a Hospital or Skilled Nursing Facility (SNF). 
•  Part B covered drugs:  These are drugs that are usually administered by a doctor or in an outpatient facility. This can be at the doctor’s office or dialysis center and chemotherapy facilities. The facility must first purchase the medication and administer it in their offices. Any drugs paid by Medicare Part B must always be paid by Medicare Part B. Part D coverage will not be able to pay for any drugs covered by Medicare Part B. 
• Part D covered drugs: These types of drugs are medications that will normally be prescribed by a doctor and picked up at the pharmacy. 

 Important: There are some drugs that may be covered by Part B or Part D depending on how they are administered. 

The Basics of Part D 

Prescription drug coverage in Medicare is mostly covered by Medicare Part D. This is a standalone health plan that is not included in Original Medicare, that covers most, outpatient prescription drugs. The plans are provided by private health insurance companies for people who are enrolled into Original Medicare or Medicare Advantage plans. For a majority of people, the best time to apply for Medicare Part D is when they are first eligible for Medicare, or if they have a Special Enrollment Period (SEP). If Part D enrollment is not done when initially eligible, and there is no alternate creditable coverage, there may be lifelong penalties for late enrollment. 

 Medicare Part D plans will usually have a formulary of drugs, which is a list of drugs that are covered by the plan. Not every drug is covered by every plan, but if your medication is not on the plans list of drugs, or formulary, then you may be able to request an exemption.

 Medicare Part D plans must cover at least two drugs in every category of drug. This means they will have at least two prescriptions for every illness but may not cover every drug for every type of illness. But for specific categories they must cover every drug:

• HIV/ AIDS Treatments
• Antidepressants
• Antipsychotic medications
• Anti-convulsive treatments
• Immunosuppressant drugs
• Anti- Cancer drugs (unless covered by Medicare Part B)

Additionally, most Vaccines will be covered under Medicare Part D coverage, unless covered by Medicare Part B

 There are some drugs that cannot be included in Medicare Part D coverage; these would be : Weight loss, Weight again, over the counter drugs and medications purchased from outside the country.

What Is Medicare Part D ?

Medicare Part D is coverage for prescription drugs. It is possible to get Part D coverage either through a standalone Medicare Prescription Drug plan (PDP) or a Medicare Advantage plan (MAPD). Both types are available through Medicare approved private insurance plans.

 Although Medicare Part D prescription drug plans (PDP) are optional, it is best to enroll in one as soon as possible. This is because if delayed, and without credible coverage from work or alternative healthcare plans, there is a late enrollment penalty that may raise your costs for the plan for the rest of your life.

The cost for these Medicare Part D prescription drug plans (PDP) will vary from company to company depending on the benefits included in the plan. Additionally, benefits and drugs covered by the plan will vary from year to year. It is best to review your Medicare Part D prescription drug plan (PDP) coverage every year to ensure it still fits your needs and your budget.     

More important things to know about Medicare Part D prescription drug plans (PDP).

 Regardless if you have a Stand Alone Medicare Part D prescription drug plans (PDP) or a Medicare Part C Medicare Advantage and Prescription drug plan (MAPD) there are some important things to know:

• Some plans will have Annual Deductibles for their Medicare Part D prescription drug plan (PDP) coverage. This means that you will have to pay 100% of the cost of your medications prior to meeting the deductible every year.
• After you have met your deductible you will start to pay a share of the costs or a flat copay depending on the type of medication.
• In 2021 if your combined costs equal more than $4130 a year then you will enter into the donut hole, which means your cost will change to 25% of the cost of your medications. The limit to when this period begins changes every year.
• At the point you have paid the maximum annual amount for your medications allowable, you will enter into the “catastrophic stage”. At this point your costs will drop down to a minimum amount per medication. The catastrophic stage begins at $6,550 for 2021. This amount usually changes from year to year.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.