The Medicare Program provides Medicare Part A which covers hospital bills, Medicare Part B which covers medical insurance coverage, and Medicare Part D which covers prescription drugs.
Medicare Part D provides prescription coverage through state Prescription Drug Plans (PDP) which can vary from state to state. In addition, each PDP has a Drug Formulary (list) of allowable or covered medications. Covered medications also vary between plans, so it is important, if you find you are paying too much for your medications even while on a PDP, to go to the Medicare website and use the Formulary Finder to find a PDP that covers more of your medication costs.
Many of our customers are eligible for both Medicaid and Medicare. These "dual eligibles" are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit. The Medicare Part D plan becomes the primary prescription coverage and Medicaid is the secondary drug plan and may or may not pick up some or all of the remaining drug costs, depending on the medications.
Dual eligibles have unique considerations under the Medicare Part D program in that they can change from one PDP to another PDP every 30 days without penalty if they determine that another plan would provide better prescription coverage for their personal medication. It is important when changing PDPs to insure that the plan you are leaving will pick up your drug costs every day until the next PDP picks up costs. Sometimes, if you change plans early in a month, a plan may not cover the remaining portion of that month, so you could have a gap in coverage until your new PDP takes over. Be aware of this and ask questions to make sure you are covered.
MyMedicare.gov provides direct Internet access to your Medicare benefits, eligibility, enrollment (including prescription drug plans) and preventive health information - 24 hours a day, 7 days a week. Visit the site, sign up, and Medicare will mail you a password to allow you access to your personal Medicare information. MyMedicare.gov also allows you to view your adjudicated claims information, access online forms and publications, and receive important messages from Medicare.
Here are some Medicare Part D resources you may find useful:
Your Pharmacy Alternatives pharmacist can provide further guidance about whether or not your medications will be covered and what reasonable substitutions might be. Then you can take this information to your physician. Please contact us if you need further information.