How much will it cost to join a Part D plan, and what drugs does it cover?
Monthly premiums for stand-alone Part D plans, and for Part C Medicare Advantage managed care plans that include drug coverage, run from about $10 to $75 per month, depending on which plan someone chooses and where he lives. The average cost of a plan is about $25 per month; a few plans have no premium at all. Generally, plans with the broadest coverage and lowest copayments have the highest premiums.
No plan covers every prescription drug, or even comes close. First, by law some drugs are not covered at all: these include certain sedatives, tranquilizers, sleeping pills, drugs used for weight loss or gain, and over-the-counter medications.
Medicare only requires each plan to cover two drugs -- either brand-name or generic -- in each "therapeutic class" of medications. That means that for any disease or condition, a plan covers some but not all drugs. The specific drugs a plan does cover are included in a list called a formulary. A plan pays its share only of the drugs listed on its formulary and purchased from a pharmacy -- either a store or a mail-order service -- that participates in that plan.
Unfortunately, every year each plan changes the drugs it includes in its formulary. The fact that a plan now covers all of someone's drugs doesn't mean that it will next year, which means the person who's covered has to stay on his toes. Each autumn, when all plans announce changes in their formularies for the following year, he must check to make sure his drugs will still be covered by his current plan. If not, he'll want to consider changing plans.
Are there restrictions on coverage other than the formulary list?
Knowing that the drugs someone takes are included in a plan's formulary list doesn't tell you everything about coverage. Plans can place other restrictions on drug availability or cost; for instance, they may create drug tiers in which the copayment for brand-name drugs is more than for generic equivalents, or the copayment for one brand is more than for another.
Also, plans are permitted to do "drug substitution," in which an individual's doctor prescribes a drug but the plan covers only its generic form or a different "equivalent" drug. The plan might also require prior authorization for certain restricted drugs; or it can stipulate "step therapy," which means he must try a less expensive medicine within a particular class of drugs before the plan will pay for a more expensive one.
I've been a Part D participant since the program began. Part D hasn't helped me at all. Prior to Part D, the insurers providing Medicare Part B, offered supplementary prescription drug coverage options. The premium cost for these drug coverage plans was approximately the same as that of Medicare Part D. The difference is that the pre-PART D Plans put a cap limit on annual coverage. However the limited annual coverage was between $1800-$2200 per year; which was a much higher amount, than was the low end of the Medicare Part D Prescription coverage doughnut hole, when the plan went into effect. And this was more than 5 years ago so, undoubtedly, left alone without Govt meddling, the coverage amounts would have increased by now. Hence, the free market provided a better coverage for less money than Medicare Part D, to individuals like me, who pay more than average for drugs per annum, but less than someone requiring catastrophic prescription drug coverage. Today, my total out of pocket prescription drug costs, are more for the same medications, than they would have been if the Government had never created Medicare Part D. I realize that some people, probably most people have benefited greatly from Part D, however, I have not. I’ve been damaged and the fact that I am now trapped, without a better available option; is further proof of how Government, by definition can never adequately provided for the individual citizen.
First call Medicare & ask for advice, you should also contact the maufacturer of the drugs you need & see if they'll help you. Good luck
I am 60 years old and drawing my exs social srcurity.It they put me on medicare and it leaves me paying $122.00 of my meds.I don"t have enough money to get my meds. I am a diabetic and take insulin and other meds. without these I could die.What can I do?