What to Know About Prescription Drug Plans

A part of being an adult is applying for a Medicare plan that is right for you. Also, as we age more, the need to take prescription drugs is as high as ever. According to Wikipedia, 88% of older adults (62 – 85 years old) use at least 1 prescription drug, while 36% use 5. Is it beneficial to you if you enroll for the prescription drug plan (PDP)? Continue reading to find out if a PDP is right for you.

WHAT IS A PRESCRIPTION DRUG PLAN?

The Medicare prescription drug plans, which are also known as Medicare Part D, is a program that gives subsidies to people that need to buy prescription drugs. Those who are entitled to Medicare Part A and Medicare Part B can voluntarily enroll in this plan. There are certain coverage-tiers, and not all drugs are covered by this plan. No physical exams are required and a person cannot be denied for health reasons. Those who are enrolled in this plan will need to pay monthly premiums.

WHAT ARE THE BENEFITS OF A PRESCRIPTION DRUG PLAN?

The main benefit of the prescription drug plan is access to affordable prescription drugs. This is especially helpful for people who need to take more than one prescription drug. According to USA Today, Pfizer will raise the cost of 41 drugs beginning in January of 2019. When a person is enrolled in a PDP, these amounts will be slashed significantly.

You need to take note that there are drugs that are not covered in this plan. Sites like eHealth have a tool to review the formulary or the list of drugs covered. It is recommended to check it out before applying. If you need a medicine that is not covered with your plan, your coverage will be useless and you’ll just be wasting money. It is better to check the drugs that are covered before laying your money on the table.

Based on your plan, there are three groups of drugs covered:

Group 1 is the drug coverage before your deductible. When your plan covers your drug before your deductible, your purchase will be subject to copayments or coinsurance. The slash in the price will depend on whether the drug is generic or branded.

Group 2 is the drug coverage after your deductible. In this tier, you will need to buy your own drug. Until the cost meets a certain annual amount, the plan will not kick in.

Group 3 is the coverage after a special prescription drug deductible. The deductibles are separate from other deductibles. Once this special deductible is paid, your drug will be covered with a co-payment.

WHO NEEDS TO TAKE IT?

People who are taking prescription drugs will benefit from a PDP. The slashed price for covered prescription drugs is worth all the hassle of paying the premium. The deduction may sometimes be based on your income and other factors. Those who are qualified for Part D’s low-cost Extra Help program will have bigger savings. People who are taking a lot of prescription drugs are the ones who will feel more of the benefit in their programs. People with individual insurance, also qualifying for a PDP, can still enroll on the latter.

WHO NEEDS TO AVOID IT?

Those who don’t use prescription drugs are the ones who will not benefit from this plan. You can still enroll for a PDP under a low-cost plan, even when you don’t need prescription drugs right now. In this case, if you suddenly need a prescription plan, you will already be covered.

This is also applicable to those who already have drug assistance that is better than what the PDP offers. Examples of those who are enrolled in the Federal Employees Health Benefits Program (FEHBP) are military retirees enrolled in the TriCare-for-Life Program, veterans enrolled in the Department of Veterans Affairs health care program, and people who get their drugs from the Native American health service. These health care programs are better than PDPs.

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