Medicare Drug Plans
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With the privatization of some of the Medicare programs have come options. There are a multitude of companies that are offering prescription drug coverage. These range from very simple programs to very complex programs. Some cover only generic or low cost medications while others have multiple scales of coverage depending on medication, brand etc. Some medication coverage is part of an all-inclusive plan for hospital and medical care.
Preparation
Before you begin looking at the individual plans available in your area there is some information you need to gather and understand first. You will need to get a list of all your medications. You will need to find out which ones are generic, or which ones you can tolerate the generic form of. There are times when the generic is not as good as the brand name. The inert ingredients may make a huge difference in how well the medication works for you. There are certain drugs that are more prone to differences relating to there manufacturing process than others. You need to know how much you are paying for each medication. These factors will all play into your final decision on a prescription drug pan. Many people get overwhelmed with the amount of information and research necessary to get the best plan for them. If you gather your information and take your time it will make the decision process easier. If you feel overwhelmed ask a friend or family member to help you with your decision. If you still feel like it is too much get some help from a financial planner.
Medicare gap
Each drug plan has limits on the amount of coverage that they provide. The gap or donut hole is the time between where the regular coverage stops and the catastrophic coverage begins. Once you have reached the regular coverage limit (2,500 paid by plan) there is a 3,600 dollar out of pocket expense that must be met before catastrophic coverage begins. Some people never get over the regular coverage while for others the get over it very soon. This gap and how your personal medications cost are incurred will be a major deciding factor in your choice of plans. There is gap insurance but you will need to decide if your drug use makes that a necessary choice and if you will actually decrease your overall drug spending with the supplemental plan.
Formulary
Until Medicare became a part of your life this was a term you probably never heard of. Depending on your prescriptions this is a very important term. The drug plan’s formulary is the plans preferred list of drugs. The medications you take need to be part of the drug plans formulary. If a plan does not accept a brand name drug in their formulary than your costs for that drug will be higher or not covered at all. Some plans will make exclusions if you can prove that the brand name medications you use are the only ones that have been successful with your symptoms. This requires you to try other drugs that may not work as well or at all. In the case of seizure disorders changing medications or brands may not be in the best interest of your health.
Tiers
This is another term that you may not be familiar with that can have a huge impact on your financial life. Each drug plan has its own unique formulary and co-pay tier system. Depending on the level (tier) your drug falls into will determine your co-pay. Since there is so much variation in plans this is another aspect that needs evaluation in choosing a plan. You will want the majority of your drugs in the low tiers. The higher the tier the higher the out-of–pocket cost is for that medication.
Next Step: Medicare Drug Plan Formulary
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