Medicare Part D - Prescriptions

Although Original Medicare will cover healthcare services like hospital treatment and medical care, it does not include coverage for prescription medications. If you need a policy to help pay for your prescription drugs, you will need to purchase Part D coverage.

What Is Part D?

Medicare Part D is a drug coverage option that is serviced by insurance providers that contract with Medicare to provide you with benefits. Through Part D, you can have some or all of the costs of some prescription medications covered.

How Does Part D Coverage Work?

Medicare Part D policies provide coverage for a select list of prescription drugs, this list is called the formulary. The formulary you have access to will vary based on your plan, but all Part D policies must provide access to at least two drugs in the most commonly prescribed categories and classes. In this way, Medicare ensures that regardless of the Part D plan you choose, you will have access to the drugs you need.

Although the formulary may not include the specific drug you are accustomed to using, a similar drug should be available. Suppose none of the listed drugs suit your medical needs. In that case, you may ask your insurance provider for an exception, wherein they will adjust your policy to accommodate an alternative drug.

What If My Part D Plan Changes?

If your prescription drug plan makes changes to their list of offered drugs, affecting one of the drugs you are taking, they must do one of the following:

  • Give you written notice at least 30 days before the change takes effect
  • Provide you with at least a month’s supply under the former plan rules and give you written notice of the change
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How To Enroll In Medicare Part D Prescription Drug Coverage

To enroll in a Part D policy, you must have already enrolled in either Part A or Part B of Original Medicare. You must also live within the service area of your desired prescription drug plan.

Once you decide to enroll, you can apply directly through the insurance company offering the plan you wish to enroll in. A licensed insurance agent can also guide you through this process.

You can only enroll in Part D policies during certain periods. They are as follows:

  • Initial Enrollment Period – Begins three months before your 65th birthday and ends three months after. The period includes your birth month, meaning the period lasts a total of seven months. 
  • Annual Election Period – October 15th to December 7th
  • Special Election Period – Unique enrollment period that is offered to individuals whose situation meets certain criteria. Contact an insurance expert to learn whether or not you qualify for a Special Election Period.

If you choose to enroll outside of any of these periods, you may be subject to a late enrollment penalty resulting in higher premiums for your Part D policy.

Proinsurance Hawaii will help you determine whether a Part D plan is right for you. Contact us now for more details.