Presumably, if you have a Medicare Part D Plan or a Medicare Advantage Plan (Part C) that includes Part D drug coverage, you looked at its formulary before you made the decision to enroll in the plan. Perhaps since then, however, you have developed a need for another medication which is not covered by your health plan. What can you do in this circumstance? You have several options. Consult Your Doctor The first step is to consult your doctor. Your health plan's formulary is the list of drugs it will cover. If your plan does not cover the medication you need, perhaps there is another similar drug in the formulary, which your doctor should know about. In some cases there are other factors involved: The drug you need may require prior authorization. This means that your doctor must notify the plan that for you this drug is medically necessary. Your plan may require step therapy. This means that before your more expensive drug is authorized, you need to try a less-expensive one or … [Read more...]
Am I Required To Join A Medicare Drug Plan?
No, you are not required to join a Medicare drug plan- joining a drug plan is your choice. However, to have Medicare help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage. These plans are run by an insurance company or other private company approved by Medicare. There are 2 ways to get your Medicare prescription drug coverage Part D (PDPs)- These plans are stand-alone plans that add drug coverage to Original Medicare. Medicare Advantage Plans (MAPD)- You get all of your Part A and Part B coverage as well as prescription drug coverage (Part D) through these plans. You must have both Part A and Part B to join a Medicare Advantage Plan. Each plan varies in both cost and drugs covered. You can choose to join the plan that best meets your needs. Consider enrolling during your Initial Enrollment Period, even if you do not use a lot of prescription drugs at that time, because there is a penalty for waiting. Because of this penalty, if you … [Read more...]