Get the Best Prescription Drug Plan for Your Needs

Many seniors in Florida and Texas take more than one prescription medication. 

If you’re not currently taking anything, the chances are high that you may need medication in the future. You can enroll in Medicare Part D during your IEP — the months surrounding your 65th birthday — to help manage the ever-rising costs of prescription drugs.

How You Can Get Medicare Part D

There are two ways to get a Part D plan:
  1. Join a Medicare Advantage plan that has built-in drug coverage, or
  2. Enroll in a separate Part D plan.
You can get a stand-alone Part D if you have either Part A or Part B. Every insurance company decides which drugs they’re willing to cover and at what cost — and they provide the information in their formulary. Check to make sure your prescriptions are listed before enrolling in the plan that interests you.

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Part D Late Enrollment Penalty

Even if you don’t take any medications, we advise you to sign up for Part D plan. Let’s assume you’re taking several medications 10 years from now and one of them is name brand. In that case, when you sign up for Part D, you’ll be penalized for each month that you were eligible for that prescription but didn’t enroll. Unfortunately, that penalty doesn’t go away. It’s something you must pay on top of your monthly premium for your plan — every month — for life.

You want to sign up for Part D when you first go on Medicare to avoid a costly penalty down the road.

More About Part D Enrollment

If you’re still working at 65 — for an employer with more than 20 employees — and enrolled in the employer’s group health insurance, you can delay Part D enrollment until you retire. Just make sure your employer coverage offers a qualifying prescription drug plan.

There are other times outside of your initial enrollment period when you can join a Medicare drug plan:

  • During Special Enrollment Periods: for example, when you retire and lose that employer coverage or if you move out of the coverage area, you’ll be given a special period to enroll.
  • During the Annual Enrollment Period: you can enroll, disenroll, change your plan, or join a Medicare Advantage plan with Part D coverage between October 15 and December 7.

Not sure whether you qualify for a special enrollment period? Contact us.

A Glimpse of Part D Costs

You’ll still be responsible for some costs with Medicare Part D. This can get complicated, but we’ll break it down for you.

Most beneficiaries who are enrolled in Part D have some of the following out-of-pocket expenses:

  • A plan premium each month
  • A deductible each year (In 2021, this amount is $445)
  • A share of costs for your drugs covered — either a coinsurance or copayment during your initial coverage period
  • A percentage of your drug costs after the initial coverage period and before the catastrophic coverage starts

As a reminder, your specific costs will vary by plan.

Copays and Tiers

To lower costs, many prescription plans place drugs into different tiers on their formularies. Every plan can arrange their tiers differently, and every tier has different costs. But generally, a drug in a lower tier will be more affordable than a drug in a higher tier.

For instance, a prescription drug plan’s tiers may be set up like this:

  • Tier 1: Preferred Generic — lowest cost
  • Tier 2: Generic — low cost 
  • Tier 3: Preferred Brand-name — medium cost
  • Tier 4: Non-Preferred — medium-high cost
  • Tier 5: Specialty — highest cost

Note: Costs for the tiers will vary from company to company and plan to plan.

What Else You Should Know

-You can only be enrolled in ONE Part D or Medicare Advantage plan at a time.

-If you have Original Medicare and a Medigap plan, you’ll want to look for a stand-alone drug plan. Medicare Supplement plans don’t cover prescription drug costs.

-People with low incomes and limited resources can get help from the federal government to pay for prescription drugs. You can contact your local Social Security office to find out if you qualify for Extra Help.

Work with a Medicare Expert in Florida.

The prescription drug costs and coverage vary by plan and may change each year. So, it’s important to review your Part D plan on an annual basis. And Lacayo Group Insurance can help. 

There’s a reason we call ourselves Medicare experts. If you choose to work with us, we’ll review your insurance policies every year. We’ll be in touch with you to make sure you’re in the right prescription plan that meets your needs — and at the right price. 

If you’d like assistance with Medicare Part D, our licensed Florida agents are here for you. Please call the number on your screen!