• Medicare Prescription Drug Plans (sometimes called “PDPs”) add prescription drug coverage to Original Medicare, some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans, and Medicare Medical Savings Account (MSA) Plans.
• Some Medicare Advantage Plans (like HMOs or PPOs) or other Medicare health plans offer prescription drug coverage. You generally get all of your Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and Part D through these plans. Medicare Advantage Plans that offer prescription drug coverage are sometimes called “MA-PDs.”

To join a Medicare Prescription Drug Plan, you must have Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). To join a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan with prescription drug coverage, you must have Part A and Part B. You must also live in the service area of the Medicare health plan or drug plan you want to join. To learn more about Medicare prescription coverage in the Staten Island area, contact Mark Turner Insurance.

All Medicare drug plans must give at least a standard level of coverage set by Medicare. However, plans offer different combinations of coverage and cost sharing. Medicare drug plans may differ in the prescription drugs they cover, how much you have to pay, and which pharmacies you can use. If you decide to join a Medicare drug plan, compare plans in your area and choose one that meets your needs. If you don’t join a Medicare drug plan when you’re first eligible for Medicare, and you don’t have drug coverage that’s expected to pay, on average, at least as much as standard Medicare prescription drug coverage (called creditable prescription drug coverage), you may have to pay a lifetime late enrollment penalty if you join later. The penalty is in addition to your premium each month for as long as you have a Medicare drug plan.

Everyone with Medicare has to make a decision about prescription drug coverage. If you don’t use a lot of prescription drugs now, you still may want to think about joining a Medicare drug plan to help lower your drug costs now and help protect against higher costs in the future. If you’re new to Medicare and already have other drug coverage, you have new options to think about. If you aren’t new to Medicare, you may want to look at your options to find drug coverage that meets your needs. Contact our agency in Staten Island to get started with a Medicare prescription coverage plan. You can join or switch Medicare drug plans between October 15– December 7 each year, with your coverage beginning January 1 of the following year.

Consider all your drug coverage choices before you make a decision. Look at the drug coverage you may already have, like coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy. Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options. If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.

Note: Drug coverage is insurance. Doctor samples, discount cards, free clinics, or drug discount websites aren’t drug coverage.

Compare these things to find a plan that meets your needs:

Coverage
Medicare drug plans cover generic and brand-name drugs. All plans must cover the same categories of drugs, but generally plans can choose which specific drugs are covered in each drug category.

Cost
Plans have different monthly premiums. How much you pay for each drug depends on which plan you choose. If you have limited income and resources, you may qualify for Extra Help from Medicare with paying your drug plan costs.

Convenience
Check with the plan to make sure the pharmacies in the plan are convenient to you. Many plans also allow you to get your drugs by mail. If you spend part of the year in another state, see if the plan will cover you there.

Medicare Part B (Medical Insurance) includes limited drug coverage. It doesn’t cover most drugs you get at the pharmacy. You’ll need to join a prescription drug plan to get Medicare coverage for drugs for most chronic conditions, like high blood pressure. Part B covers certain drugs, like injections you get in a doctor’s office, certain oral cancer drugs, and drugs used with some types of durable medical equipment—like a nebulizer or external infusion pump. Under very limited circumstances, Part B covers certain drugs you get in a hospital outpatient setting. You pay 20% of the Medicare-approved amount for these covered drugs. Part B also covers the flu and pneumococcal shots. Generally, Medicare drug plans cover other vaccines, like the shingles vaccine, needed to prevent illness.

Note: Medicare Part A (Hospital Insurance) or Part B generally doesn’t cover self-administered drugs you get in an outpatient setting like in an emergency room, observation unit, surgery center, or pain clinic. Your Medicare drug plan may cover these drugs under certain circumstances. You’ll likely need to pay out-of-pocket for the entire cost of these drugs and send in a claim to your drug plan for a refund of the portion not covered. Call your plan for more information. Also, visit Medicare.gov for more information on how Medicare covers self-administered drugs you get in a hospital outpatient setting.

If you are located in Staten Island and are looking for Medicare prescription coverage, reach out to the experts at Mark Turner Insurance.