Florida Medicare Part D - Prescription Drug Plans
What Is Part D Medicare?
Part D is Medicare prescription drug coverage. In many cases Part C plans will cover prescription drugs. If you're enrolled in a Medigap Plan (Medicare Supplement), then you will usually also want a separate Part D plan to cover prescription drugs.
Medicare Part D Eligibility
Eligibility for Medicare Part D is the same as eligibility for Medicare Part A. (nearing age 65, or disability.)
Medicare Part D Plans 2022-2023 (Medicare Part D Cost Comparison)
This is a service we provide. We use computer programs to check prices for your existing prescriptions and then compare plans for you on a lowest cost basis.
Medicare Part D Cost
Stand-alone prescription drug plans will usually carry a small monthly premium, in addition to copays and coinsurance. If you're enrolled in a Medicare Advantage Plan (Part C), your prescriptions will usually be covered through that, and you may have no premiums.
What Drugs Are Covered By Medicare Part D?
Drugs are divided into "tiers" with different coverage, copays, and coinsurance. Different companies charge different amounts, so the answer to this question will be different depending on your particular prescriptions. This is also true with Medicare Advantage Plans (Part C) that have prescription drug coverage. (MAPD for Medicare Advantage + Part D).
Florida Medicare Part D Prescription Drug Plans are required to cover all drugs in 6 protected categories
These 6 categories are:
· Medications that manage seizures.
· Medications that manage Depression.
· Medications used to treat mental disorders.
· Medical inhibitors of the activity of the immune system.
· Medications that lower HIV viral load for positive patients.
· Medications that treat or manage Cancers.
Each plan contains a specific list of drugs known as a formulary. The formulary includes the out-of-pocket expendss for each drug. Formularies vary from plan to plan. Selecting a plan that best suits a person is necessary. A formulary comprises levels of medications known as tiers. The tiers are different based on the cost of drugs per tier.
The tiers include:
· Tier 1: It contains the cheapest medicines that a plan covers. These are generic and a few inexpensive brand-name drugs. An example of Tier 1 drugs is cheap drugs treating bacterial infections.
· Tier 2 includes generic medicines and some brand-name medicines. Synthroid, a hormone replacement medicine, falls into this category. This group consists of more expensive drugs than tier 1.
· Tier 3 includes drugs that are more expensive compared to the first two tiers. The drugs are Brand-name drugs.
· Tier 4 has newly developed medicines and specialty medications. Examples are non-insulin diabetes drugs.
· Tier 5 includes specialty drugs.
Tier exceptions apply when the expenses are high for a patient. High-sharing costs are due to a patient's condition that requires expensive drugs. Payments are higher when cheap drugs are dangerous for the situation at hand. To apply for Tier exceptions, follow the Part D appeal process.
To apply for a tier exception, a supporting document from a prescribing doctor is necessary. It explains how low-tier drugs are ineffective on a patient's condition. The plan decides for 72 hours and gives a response. Fast appeals apply for needs that cannot wait for 72 hours. When a plan approves the request, the costs are similar to low-tier drugs.
Tier exceptions are effective for one year. When one year is over, the exceptions require a renewal. The renewal period is during Fall Open Enrollment Period.
Medicare Part D Penalty
There is a late enrollment penalty for Medicare Part D, and it's a big one. If you do not enroll in Part D when first eligible (Or a Part C plan that includes Part D), there is a late enrollment penalty for life. It's 1% of the "national base beneficiary premium" per month. In 2021, that is $33.06.
You can delay Part D enrollment without a penalty, if you have "creditable coverage" through private insurance. That means your coverage has to be at least as good as Medicare Part D coverage.