Will my prescription drugs be covered under any plan I choose?
Answered by 6 licensed agents
No. Every Medicare Part D and Medicare Advantage prescription drug plan has its own formulary, which is a list of covered medications. A drug may be covered by one plan but not another, or it may be placed in a different tier with different copays.
Before enrolling, always check that your medications, dosage, and preferred pharmacy are covered. The best plan isn't necessarily the one with the lowest premium—it's the one with the lowest total annual cost for your specific prescriptions.
Each Part D plan and Medicare Advantage Prescription Drug (MAPD) plan has its own formulary (list of covered drugs), drug tiers (which affect your copay or coinsurance), pharmacy network and coverage rules, such as prior authorization, step therapy, or quantity limits. If you are considering changing plans, its a good idea to always check with the carrier before switching to ensure your particular prescriptions are covered under the new plan.
Most people are not aware that there are two approaches to solving the Medicare puzzle. If you enroll in Original Medicare, Part A coverage includes costs of drugs supplied during a hospital stay. Part B (the part that costs most people each month) does not include coverage for outpatient prescriptions. That means you should also enroll in a stand-alone Part D plan to cover outpatient prescriptions.
If you enroll in a Medicare Advantage plan, which replaces Original Medicare and its options, you may pay nothing additional more than the monthly Medicare premium and also receive similar prescription coverage as above - but your costs may actually be lower. These are 100% private insurance plans and some are not-for-profit
Coverage varies by plan, so it's important to check that your specific medications are on a plan's formulary before enrolling. I also check whether you qualify for Extra Help (LIS) based on your income, since that can significantly lower your drug costs regardless of which plan you choose.
Not necessarily, You will need to check to see if a plan covers your specific medications and at what cost. Work with a local broker who will help you check your drugs and which plans will be most suitable?
Not necessarily, every Medicare Part D and Medicare Advantage prescription drug plan has its own formulary (list of covered medications). Even if a plan covers your medication, your cost may vary depending on the plan's formulary, pharmacy network, and drug tier.
