Medicare Part D is prescription drug coverage provided through private insurance companies. Enrollment is voluntary, but you must choose and enroll in a plan to receive prescription coverage. Part D covers most oral PH medications, but not treatments administered intravenously or by nebulizer.

As when you choose any kind of insurance plan, do your research and compare plans. Follow the steps below to help find the right Medicare Part D plan for you.

Decide what type of prescription plan you want. Choose a standalone drug plan that offers just drug coverage if you have original Medicare and want to keep it. If you have a Medicare private health plan (such as an HMO or PPO), you generally should get drug coverage from the same company. If your private health plan is a Medicare Savings Account, private fee-for-service or cost plan, you can choose a Part D plan.

Gather your prescription information. List the pharmacies you use regularly, the medicines you take and how much you pay for them. Use this PHA worksheet to make your list.

Don’t hesitate to seek help. Call 800-MEDICARE (800-633-4227) or compare plans with the Medicare Rights Center’s guide.

Coordinate with your other benefits. Call the company that provides your current coverage to find out if and how it will work with the Medicare drug benefit. Many employer plans don’t allow you to have Part D, so you should ask:

• Will the Medicare drug plan work with my current drug coverage?
• Could I lose my retiree or employer health coverage if I join a Medicare drug plan?

Investigate your out-of-pocket costs and potential costs for different drugs.

If your income is very low, you can get extra help to pay for most costs, but you generally should investigate how much you’ll pay at the pharmacy (co-payments or coinsurance) for each drug you need. Certain drugs may have high co-insurance.

Questions to ask

How much will I pay in monthly premiums and deductibles?

• If a drug I take has high co-insurance, is there a drug that will cost less, such as a generic?
• Does the plan have a “coverage gap” when I must pay my full drug costs?

Investigate which drugs your plan covers. Each private plan has its own list of covered drugs (a formulary) with various costs and restrictions. Here are questions to ask your doctor:

• Does this plan cover all the medications I take?
• Does the plan cover the most important medications I take?
• If the plan doesn’t cover a medication I take, does it cover one that will work for me?
• Does the plan require prior authorization or step therapy before it will cover a medication I need?
• Does the plan cover PH medications I might need in the future?

Ask about your pharmacy network. You usually pay the full cost of non-covered drugs and prescriptions from out-of-network pharmacies. If you have pulmonary hypertension, pay special attention to your pharmacy network. It’s critical that you can receive your medications through specific specialty pharmacies. Questions to consider include:

• Can I fill my prescriptions at pharmacies I use regularly?
• What happens if I go to pharmacies that aren’t in my network?
• Can I fill my prescriptions by mail order?
• Can I fill my prescriptions when I travel?

When to enroll in Part D

Enroll in or change your Medicare Part D and/or Medicare Advantage (Part C) plan during the fall open enrollment period (also known as the annual coordinated election period). New enrollments and changes made during this period become effective Jan. 1.