When it comes to prescription drug plans for seniors, you have options. Learn about Medicare Part D and the basics of choosing a prescription plan.
As you approach retirement age, you’re probably also looking forward to becoming eligible for Medicare.
All too often, seniors assume that prescription drugs are covered under Medicare Part A and Medicare Part B. This is not the case. You will be responsible for securing your own prescription drug coverage. Medicare Part D will cover medications needed outside of a professional care setting.
As you approach retirement, health insurance is a major consideration, and prescription drug coverage will go hand-in-hand with that healthcare. The cost of some life-saving drugs is on the rise, and without adequate coverage, you may have to make some difficult decisions.
We don’t want that to happen. You and your retirement nest egg should be protected against unexpected pharmaceutical costs—and that can only happen under the coverage of a Medicare-approved prescription drug plan.
You’ll have some research to do, since plan costs vary, along with the types of drugs each plan covers…but you won’t have to do it alone. The Senior Life is here to help.
Two Types of Prescription Drug Plans for Seniors
When you enroll in Medicare, you will have the option to purchase drug coverage as well. Even if you don’t currently take any medications, we recommend that you look into prescription drug plans for seniors at the time you enroll. Otherwise, you’ll pay penalties, in the form of higher premiums.
There are two different ways you can acquire Medicare-approved drug coverage.
The first is to enroll in a Medicare drug plan, which adds prescription drug coverage to Original Medicare (Part A or B), some Medicare Cost Plans and certain Private Fee-For-Service plans.
The second is to enroll in Medicare Part C or any other Medicare plan that includes prescription drug coverage.
Currently, 43.5 million Americans are enrolled in Medicare Part D.
A little more than half of them have stand-alone prescription drug plans, while a little less than half are enrolled in a Medicare Advantage plan (KFF). If that already sounds complicated, understand that you’re not alone in that assessment.
Let’s start at the beginning by making a list of things you’ll need to know before you shop prescription drug plans for seniors.
Before You Enroll in a Medicare-Approved Drug Plan
When it comes to finding the prescription drug plan that’s perfect for your retirement, some decisions are best made before you shop.
Here are some questions you should answer first:
- What drugs are you currently taking?
- Which of those drugs are generic?
- What is your financial tolerance for additional future medication costs?
- Are you able to cover fluctuating drug costs throughout the calendar year? Or will you be on a fixed income, requiring monthly expenditures to remain constant?
- How important are low premium costs?
- How important are extra benefits?
- Will you tolerate restrictions on your choice of doctors, providers and hospitals?
- Will you need home delivery of medications?
After you have answers to these questions, you can start looking for your Medicare-approved prescription drug plan.
But before you proceed, keep in mind that if you’re currently enrolled in a Medigap plan that covers prescription medications, you should advise Medigap that you’re getting coverage from another Medicare prescription drug plan. They will remove drug coverage from your Medigap plan and your premium will be adjusted.
Keep in mind that this voluntary change in coverage can only be done during open enrollment, and those dates are subject to change.
If you already have prescription drug coverage from a plan outside Medicare, that insurance company is required to notify you if your plan offers creditable coverage. That means payments are comparable to those of a Medicare drug plan.
Choosing from Prescription Drug Plans for Seniors
As you start to research plans, some vocabulary can be helpful.
You’ll read and hear these terms:
- premium: monthly payment to keep your prescription plan active
- deductible: the amount you must pay, annually, before insurance starts to pay (Medicare deductibles are currently capped at $435)
- initial coverage: this is the period after your deductible has been met and your plan provider starts to cover prescription costs
- copayment (copay): flat fee you’re responsible for paying every time you fill a prescription
- coinsurance: percentage you’re responsible for paying every time you fill a prescription
- coverage gap: after the plan covers a set annual dollar amount, your out-of-pocket responsibilities may increase
- catastrophic coverage: after you’ve paid an out-of-pocket maximum, copayments are lowered
- step therapy: often, a generic drug will be dispensed first, to test its effectiveness (unless an exemption is filed by your doctor)
- quarterly limit: every drug comes with a predetermined limit for how much can be dispensed in a three-month period (amounts exceeding the quarterly limit must be approved by your doctor)
- prior authorization: a pharmacy may require your doctor to confirm that a prescription is medically necessary before the plan provider pays for it
The list of plans available to you will vary based on where you live.
Next, you’ll want to gather some information about all available plans:
- monthly premium
- annual deductible
- your drugs that are covered
- your drugs that are not covered
- final cost for each drug
- total monthly cost for all drugs
- participating pharmacies
- mail order availability
- coverage in more than one state (if needed)
- plan ratings
- date coverage can start
Remember those questions you answered earlier?
Compare your answers to the information you’ve gathered for each plan. One of those plans will meet all (or the majority) of your prescription drug needs and budget.
There will be contact information listed with each plan.
Have your Medicare card handy when you call them to enroll.
A Few Words About Major Prescription Drug Plan Providers
Depending on where you live and the coverage you need, you will likely see plan availability from Aetna, Cigna, Humana, WellCare and UnitedHealthcare. They are currently the major players…the big dogs.
Of course, you’ll need to look into each plan to determine which one is best for you. It’s also important to understand that coverage can change from year to year.
However, in our work with prescription drug plans for seniors, we have learned the following:
- Aetna is known for low premiums and copayments.
- Cigna is affordable with a massive array of pharmacies and covered medications.
- Humana has an expansive network, low payments and medication delivery.
- WellCare is focused on service and specializes in Medicare Advantage and prescription drug plans.
- UnitedHealthcare offers low or no drug deductibles and copayments, but all prescriptions must be filled at Walgreens.
You’re almost ready to choose a prescription drug plan, but before you go, we’d like to arm you with a bit more information.
Some Final Words About Prescription Drug Plans for Seniors
The most important thing we’d like to impress upon you is that you’re not alone when choosing a plan.
There are plenty of contact options on the Medicare website, and we have found that plan providers are typically very helpful.
You can choose to have your Medicare Part D premiums deducted from your Social Security check. You may have to wait a bit longer for your check, but you will be assured that there will be no interruption in your prescription drug coverage. Or you may wish to pay premiums directly.
No matter how you wish to proceed, it’s important to understand that there are a number of prescription drug plans for seniors available to you.
You can customize the experience to your needs and budget, so you can get on with living.
At The Senior Life, we care about your money, your safety, your health…and most importantly, we care about YOU. Have questions about investments? Social Security? Medicare? Health and wellness? Or want to stay sharp by playing games? We’ve got all that and much more on The Senior Life website. Come spend some time learning, living and enjoying retirement with us!