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Medicare Part D Prescription Drug Plans

Is a Prescription Drug Plan Right for Me?

If you are enrolled in Medicare A and B along with Medicare Supplement as your Medicare Health coverage you won’t have prescription drug coverage. Most people with this type of coverage opt for a Prescription Drug Plan (PDP).

If you have chosen a Medicare Advantage plan or are contemplating enrolling into a Medicare Advantage plan you can choose from two basic plan options, Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD).

A typical Medicare Advantage policy does not include prescription drug coverage. You could be able to opt for prescription drug coverage separate from your Medicare Advantage policy but only if you have enrolled into a Private-Fee-For-Service Medicare Advantage policy (PFFS MA).

If you opt for a Medicare Advantage Prescription Drug Plan you are opting to have a Medicare policy that includes benefits for medications. In this instance you would not need to buy a separate PDP .

What if I don’t buy a PDP?

If you elect not to purchase Prescription Drug coverage during your open enrollment and later change your mind, you might be subject to late enrollment penalties.

A late enrollment penalty is an additional amount that’s added to your Part D premium if you choose not to have drug coverage when you first enroll or if you go for more then 63 days without creditable drug coverage. The late enrollment penalty amount is calculated by looking at how long you have gone without creditable coverage. The penalty is based on the number of months without coverage multiplied by 1% of the “National Base Beneficiary Premium”. This amount might vary yearly.

What is “creditable” coverage?

If you are covered under another source of drug coverage - through a current or former employer or union, for example – you can remain in that plan and choose not to enroll in a Medicare PDP. If your other coverage is equal to the new Medicare drug benefit (and therefore considered "creditable coverage"), then you are able to continue with that plan and avoid higher payments if you enroll later for the Medicare PDP.

Does my prescription discount card count as creditable coverage?

Prescription drug discount cards have not been established as creditable coverage.

If I have other creditable coverage should I buy a prescription drug plan?

This may depend on the coverage you receive from your current plan. In most instances you aren’t allowed to have double coverage. For example if you are on an employer group policy and have creditable drug coverage and elect to also sign up for a Medicare prescription drug plan you may lose coverage for you and your family from your employer group health plan. Prior to selecting a Medicare Drug plan check with your Employer group to see if you are able have both.

If you receive TRICARE benefits or Federal Employee Health Benefits you can get prescription coverage from the health plan and also have coverage from a Medicare Prescription Drug plan.

Will all of my medications be covered by my Medicare Prescription Drug Plan?

Every drug plan has different coverage for different medications. For a full formulary search please contact Sun Coast Legacy Advisors and we are more than happy to help you. What is the “donut hole” or coverage gap?

Most Medicare drug plans have a coverage gap also called the “donut hole”. This means that a point can be reached when your plan will not pay for your prescriptions for a period of time. The coverage gap or “donut hole” begins when you and the Prescription Drug Plan have spent a specified amount for your prescriptions. When you hit the specified amount the plan will stop paying benefits for your prescriptions temporarily. You will receive a 50% discount on covered brand name drugs and pay 86% of the plan’s cost for covered generic medications until you reach the end of the coverage gap. Once you reach the end of the gap, you again have assistance from the drug plan and- in most cases - the cost of your co-pays go down.

When Can I Enroll?

There are multiple enrollment periods for Prescription Drug Plans based on when your Medicare enrollment period is. Open enrollment is when you are first eligible to join Medicare. During open enrollment you can enroll during the 7 month period that begins 3 months before you turn 65, the month of your 65th birthday, and 3 months after you turn 65.

If you eligible for Medicare because of a disability you can join during a 7month period. It begins 3 months before you become eligible for Medicare disability, the month you become eligible, the 3 months after your eligible month.

Annual Enrollment Period (AEP)is when you can sign up for a Prescription Drug Plan if you are not in your open enrollment or any special election period. During this period you can also make plan changes. The period begins October 15th and runs through December 7th.

As you can see there are many options to think about when you are deciding on your Medicare benefits. When you’re ready, contact the Medicare professionals at Sun Coast Legacy Advisors. We’ll help you sort through your options and find the plan that is appropriate for you.

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