Prescription Drug Coverage

If you are enrolled in Original Medicare, you already have Part A benefits, which cover hospital costs, and Part B benefits, which cover medical costs. But you may be interested in acquiring Part D benefits, which help pay for brand name and generic drugs.

Original Medicare Prescription Drug Coverage

To join a Medicare Prescription Drug Plan (Part D), you must be enrolled in either a Part A or Part B Medicare policy. Medicare Part D covered is served by companies that have been approved by Medicare. Their plans are required to give a standard level of coverage, but the way this coverage is delivered can vary.

Part D plans are constructed differently from provider to provider, with each offering different combinations of coverage and cost-sharing. When you are shopping for Medicare Part D policies, keep in mind that the prescription drugs they cover may differ. The amount you have to pay for prescription drugs and pharmacies you have access to may vary.

Costs

The plan you choose will have a monthly premium that is specific to the insurance provider. You will be required to pay this fee in addition to the Medicare Plan B premium. Your level of income may also result in higher premiums. 

The price you pay for drugs will also vary depending on which plan you opt into. If you are someone with limited income and resources, Grutz Financial can help you determine whether you qualify for Medicare’s Extra Help program, which helps pay Part D costs, like premiums, deductibles, and coinsurance. 

After you and your policy provider have spent a certain amount of money for covered prescription drugs, you will enter the coverage gap. In the coverage gap, you may need to pay more for your drugs out-of-pocket, up to a limit set by your provider and Medicare. As of 2021, Medicare will cover 75% of the price of generic drugs while you are in the coverage gap. 

Coverage gaps can be difficult to understand, so be sure to consult the experts at Grutz Financial for more information.  

Drug Lists

Medicare Part D plans each have a formulary or drug list. The formulary features generic and brand name drugs that are covered under their plan. Medicare drug plans are required to cover at least two drugs per drug category, meaning beneficiaries will always have access to the drugs they need.

Medicare Advantage Prescription Drug Coverage

If you would prefer to enroll in Medicare Advantage rather than stick with Original Medicare, you will still have prescription drug coverage options. A vast majority of Medicare Advantage plans offer some form of prescription drug coverage.

Choosing a Medicare Drug Plan

To choose the best prescription drug plan for your specific situation, you need to gather information about your current drug coverage needs, compare different Medicare drug plans, and eventually make an informed decision.

SeniorCare

SeniorCare is a credible prescription drug assistance program in Wisconsin. This program helps seniors 65 or older cover their drug costs. To be eligible for the SeniorCare program, you must be:

  • A Wisconsin resident
  • 65 or older
  • A U.S. citizen
  • Or have qualifying immigration status

To apply for this program, you must do so during the month of your 65th birthday, or anytime after. You will receive your benefits during the month you applied.

Grutz Financial will be there for you throughout this entire process. Our experts can help you find a plan that ensures your optimal drug coverage.

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