What if I need a drug that isn’t on the Medicare Formulary or costs too much?
If your physician determines that you need a drug that is not on a Part D plans formulary, they can ask the insurance company for an exception. However, there are rarely drugs that are not on the formulary that an insurance plan will grant an exception for. In most cases, these are experimental drugs that […]
What is a “formulary” in Part D Medicare?
A formulary is a comprehensive list of prescription drugs covered by each Part D Medicare plan. While Medicare provides guidelines to insurance companies about drug classes that must be covered, it doesn’t specify exact medications that must be included. Some drugs are excluded from Medicare’s required coverage list, but Part D plans can include them […]
I already have drug coverage through the VA. Do I still need to sign up for Part D Medicare?
In most cases, if you have drug coverage through the VA, the benefits are considered creditable by Medicare. This means that as long as you are enrolled in VA drug coverage, you don’t have to enroll in a Part D drug plan to avoid incurring a late enrollment penalty if you ever do need or […]
What does a Medicare drug formulary with tiers mean?
Every Part D plan has something called a formulary, which is a list of drugs covered under the plan. Each formulary has a set of tiers, and in most cases, Part D plans have between three and six tiers. A lower-tier drug usually has lower copays or coinsurance than a drug in a higher tier. […]
If I sign up for Part D during Medicare enrollment, how soon does the coverage start to take effect?
When you sign up for a Part D plan, your coverage start date depends on which enrollment period you use. During the Annual Enrollment Period from October 15th through December 7th, your Part D coverage becomes effective January 1st of the following year. If you enroll during your Initial Enrollment Period when turning 65, coverage […]
I am covered by Medicare, but I don’t take any medications. Is it necessary to sign up for a drug plan?
You’re not required to enroll in a Medicare Part D drug plan when you first become eligible, but if you delay and don’t have other creditable drug coverage, you could face a late enrollment penalty when you do sign up. The penalty applies if you go 63 or more days without Part D or creditable […]
What’s the late enrollment penalty for Medicare Part D, and when does it take effect?
If you don’t enroll in a Part D prescription drug plan or Medicare Advantage plan with Part D coverage when first eligible, you may face the Part D late enrollment penalty. This penalty is added to your monthly Part D premium and remains permanently once incurred. You’ll be assessed this penalty if you go without […]
Will a Medicare Advantage plan cost me more if I have a pre-existing condition or if I smoke?
The short answer is no. Medicare Advantage plans are not allowed to medically underwrite, which means they cannot charge you more or decline your coverage for any pre-existing condition. They also cannot charge you more if you are a smoker. In fact, they are not allowed to ask you any health questions when you are […]
Are covered benefits and cost-sharing requirements under Medicare Advantage plans the same thing?
Covered benefits and cost-sharing for Medicare Advantage plans are two very different things. Covered benefits are a list of specific services, tests, etc., that are covered by your Medicare Advantage plan. All Medicare Advantage plans must cover at a minimum the same benefits provided by Original Medicare Parts A & B. They also frequently include […]
I received a notice that my Medicare plan is not being offered next year. What do I need to do?
If you received a notice from your insurance company that the plan you are enrolled in is not being offered next year, you will be given options to switch to a new plan. If you are enrolled in a Medicare Advantage or Part D plan that is being eliminated, you will receive a notice from […]