Understanding Prescription Drug Coverage

What is Medicare Part D?

Medicare Part D provides prescription drug coverage for both generic and brand name prescription drugs. Prescription drug coverage also provides protection for people who are dealing with high drug costs and from unexpected prescription drug bills.

Why is it necessary to carry this extra coverage?

Given the high cost of prescription medications coupled with the coverage currently available with Medicare and other insurance plans, it is essentially a means of offering people who may require coverage now or in the future assurance of coverage.

What does this mean and who is eligible?

Any individual who receives Medicare health insurance is eligible. Eligibility for Medicare Part D begins three months prior to ones 65th birthday and also continues three months after. Regardless of medical history and income level, if you are at a minimum of three months away from your 65th birthday, you are eligible. Although coverage is not mandatory and is elective, if you want to take part in receiving this benefit, your initial eligibility is contingent upon your opting in within that six-month window. After initial eligibility, you will be unable to choose this option until open enrollment, which is November 15th to December 31st of each year. For example, if you are turning 65 in April 19, 2011, you are eligible to receive Medicare Part D commencing on January 19, 2011 and until July 19, 2011.

If you are receiving Medicare as a result of long-term disability, Part D is available; however, the criteria are slightly different. You may opt in three months prior to the three months following your 25th month of cash disability disbursements. Although you might choose to initially opt out, it is important to know that you will be subject to the same open enrollment dates as those ages 65 and older. You may be subject to a penalty upon choosing to opt out.

Why do you want Medicare Part D?

If you are eligible for the Part D plan and have not enrolled yet, it is highly recommended that you do so early on. Whether you are in the best shape of your life or not, unexpected changes can happen where prescription medication is needed. In any case, enrolling in Part D simply offers you that extra protection for prescription coverage.

Which prescription drugs are covered under Part D?

Both brand name and generic drugs are covered. To ensure that certain medications you are currently taking or may be required to take in the future is covered; you will want to check the Medicare Part D Drug Formula.

Which prescription drugs are not covered under Part D?

The following are not covered by Medicare Part D:

• Drugs that have not been approved by the FDA

• Drugs used for off-label usage (as an example: if the drug is approved by the FDA to treat a Rheumatoid Arthritis (RA), but the pharmaceutical company has discovered that it has been effective in treating another indication, such as treating psoriasis. Although their root cause may be the same, because the latter indication is not yet FDA approved, it is excluded under Part D.

• Drugs to treat anorexia, weight loss, or weight gain

• Drugs that promote fertility

• Drugs to treat erectile dysfunction

• Drugs developed for cosmetic purposes (hair growth, eyelash growth, etc.)

• Drugs that treat the symptomatic relief of cough and colds

• All barbiturates

• All benzodiazepines

• Prescription vitamins and mineral products, with the exception of prenatal vitamins and fluoride preparations

How much will Part D cost me?

As with any insurance, your monthly premiums, coverage and co-pay will depend on the plan you choose. To best decide this, you will want to take a good look at your current benefits and decide what you would like to improve upon. For example, if your current plan does not cover as much of the cost associated with diabetes medication as you would like, you will indeed want to address this when choosing a plan.

How can you minimize your out-of-pocket expenses?

Whether you decide to take advantage of Medicare Part D or not, you have more control over the prescription drugs you take than you know.

Incorporating regular exercise and healthy eating habits into your daily routine will definitely stave off the need to use several drugs, such as statins to treat high cholesterol, or Glocofage to treat type II diabetes. Any opportunity that you can take to minimize the need for maintenance drugs means that you are saving money on both costly premiums and on out-of-pocket expenses. Not all elderly people require the use of prescription medications and surely there are others that need it. With regular exercise and a balanced diet, one can achieve a healthier lifestyle.

The first step in deciding whether or not Medicare Part D is right for you is to understand the options available and to determine if the cost is worth the potential benefits. If you meet the eligibility requirements, you owe it to yourself to at least consider this prescription drug coverage and to determine if it is the right choice for you.