Medical insurance and coverage plans are extremely important, but doctor visits and hospital bills are something almost every insurance policy covers. When it comes to prescription drug plans, it can get a little tricky. Before 2006, Medicare plans pay for some drugs used during hospital admissions under Part A but it did not cover outpatient drugs.
When the Medicare Part D prescription drug benefit was implemented, medicare beneficiaries had aid to pay for outpatient drugs and prescription medication purchased. Unlike Parts A and B of Medicare, Part D is privatized, that is private insurance companies regulated and subsidized by Medicare are authorized to sell Part D coverage.
Costs associated with Medicare Part D can include monthly premiums, annual deductibles, co-insurance and copayments for certain medications, a coverage gap, and catastrophic coverage when threshold expense is met. Providers can revise their plans and policies annually, adding new benefits or medication, changing the premiums and extra costs, and so on.
Different Sources for Part D Coverage
Medicare doesn’t provide Part D coverage directly. There are two main sources for Part D coverage:
PDP’s or prescription drug plans are stand-alone companies that only sell prescription medication coverage. They do not offer doctor visits, hospital bills, or any other medical coverage.
Medicare Advantage Prescription Drug Plans or MA-PD’s are plans that offer medical, hospital, and prescription drug coverage, all under a single plan. MA plans, often known as Part C Plans, have three different types of plans, HMOs, PFFS Plans, SNP’s, and PPO’s. People who want to enroll in an MA plan need to find a plan with prescription drug coverage under the same plan.
What Is The Eligibility For Part D Plan?
Anyone with a Medicare plan is automatically eligible to enroll in a Prescription Drug Plan. To get a PDP, you must have Part A or B and for MA-PD, you must have Part A and B.
Individuals should have a permanent residence within the service area of the plan. Homeless individuals have the option of using the address of a Post Office Box, A shelter or clinic, or the address where they receive emails and social security checks.
What Drugs Are Covered Under Part D?
Medicare law outlines the medications which are covered under Medicare Part D. Some drug coverages are mandatory under this plan, while some are optional and may depend on the provider. All drugs under this coverage, however, must be approved by the FDA.
The plan commonly covers biological drugs, insulin, insulin syringes, and smoking cessation drugs. Plans have to provide coverage to individuals with Medicare, who reside in long-term medical care facilities and must offer dosage and forms of drugs that are commonly used in the facilities. Commercially available vaccines are also covered under this plan.
Certain drugs are excluded from Part D, including:
- OTC drugs
- Weight loss/gain medication
- Fertility Drugs
- Cosmetic products and Hair growth medication. (only medication sold for cosmetic purposes. Medication for underlying issues like psoriasis, rosacea, and so on will be covered)
- Vitamins and minerals.
- Drugs are covered under other parts of Medicare.
This is a list of everything you need to know about the prescription drug plan or Part D of medicare. If you still have queries, contact a licensed insurer today.