Traditional Medicare Parts A&B only cover medications given in the hospital or some administered by physicians,.so Medicare has provided for that with Part D coverage. Part D Coverage is offered as part of traditional Medicare when you initially are enrolled. It is also available through most Medicare Advantage plans as well as a stand alone insurance from private companies.
Each Medicare drug plan whether a Medicare approved one you signed up for when you were 65, part of an Advantage Plan or a stand alone insurance plan has a list called a formulary. This formulary is unique to each plan but they all share the necessity of providing at least two of the drugs prescribed for most conditions.
Most drug plans have a deductible which must be met each calendar year. While you are meeting this deductible you will pay a percentage of the drug cost. In most plans after you have met the deductible, you will be responsible for a co-pay amount for each prescription or refill. If the medication is one taken continuously, a 90 day supply may be the least expensive as well as using a generic when available.
Medicare Part D Coverage in 2020 will pay the agreed upon price of a prescription after you have fulfilled the deductible up to $4,020 dollars in that calendar year. When your plan has paid that amount you enter the “donut hole” a gap in coverage where you will pay anywhere from 45-58% of the insurers agreed upon price until you have hit the out of pocket limit when insurance coverage resumes and you can pay as little as 5%.
Every year from October 7th until December 15th there is an open enrollment period when you may change from traditional Medicare to Medicare Advantage or back again. During this time you may also add a drug coverage Part D as well.
There are penalties involved for not obtaining coverage so it is wise to consider the option of Part D coverage when you are initially eligible for Medicare.
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