FINDING A PART D MEDICARE PLAN
What Is Medicare Part D?
Medicare Part D is Medicare’s prescription drug coverage available through private companies. Enrollment is optional, but to receive prescription coverage you must choose and enroll in a plan. Part D covers most oral pulmonary hypertension (PH) medications, including Adcirca, Adempas, Letairis, Opsumit, Orenitram, Revatio, Tracleer and Veletri.
*Flolan, Ventavis, Remodulin and Tyvaso are generally covered under Medicare Part B because of the use of durable medical equipment when administered.
Find a Plan That Meets Your Needs
As with any insurance plan, you will want to do your research ahead of time and compare plans. Follow the steps outlined below to help find the right plan for you.
- Decide what type of prescription plan you want. Choose a standalone drug plan that offers just drug coverage (PDP) if you have Traditional Medicare and want to stay with it. If you have a Medicare private health plan (such as an HMO or PPO), you should generally get drug coverage from that same company. If your private health plan is a Medicare Savings Account (MSA), Private Fee-for-Service (PFFS) or Cost Plan, you can join a PDP.
- Gather your prescription information. Make a list of the pharmacies you use regularly, the medicines you take and how much you currently pay for them.
- Do your research and gather the facts.
- Visit Medicare’s plan comparison tool, call 1-800-MEDICARE (800-633-4227) or visit the Medicare Rights Center’s guide to compare different plans. Here are some important things to remember and questions to ask.
- 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 will not allow you to also 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 will generally want to investigate:
- How much will I pay at the pharmacy (co-payments or coinsurance) for each drug I need? Certain drugs may have high co-insurance.
- How much will I pay in monthly premiums and deductibles?
- If a drug I take has a very high co-insurance, is there a drug I can take that will cost me less, such as a generic?
- Does the plan have a “coverage gap” during which I must pay my full drug costs?
- Investigate which drugs your plan will cover. Each private plan has its own list of covered drugs (called a formulary) with different costs and restrictions. Here are questions you will want to ask your doctor:
- Does the plan cover all the medications I am taking?
- Does the plan cover the most important medications I take?
- If the plan does not cover a medication I take, does it cover one that will work for me?
- Does the plan require that I get special permission (such as prior authorization or step therapy) before it will cover a medication I need?
- Does the plan cover PH medications that I may 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 are a PH patient, you should pay special attention to your pharmacy network, as it is critical that you be able to receive your medications through specific specialty pharmacies. Questions to consider include:
- Can I fill my prescriptions at the pharmacies I use regularly?
- What happens if I go to the pharmacies that are not in my network?
- Can I get my prescriptions by mail order?
- Can I fill my prescriptions when I travel?
- Enroll in Part D during your Medicare Initial Enrollment Period.
It is best to enroll through 1-800-MEDICARE. If you enroll at another time, you may have to pay a late enrollment penalty. Once you’ve enrolled, you may change your Part D plan each year during the open enrollment period. If you have Medicaid and/or Extra Help – the federal program that helps pay most of the costs of Medicare drug benefit – or are in a nursing home, you can switch plans once a month.
When Can I 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). Enrollments and changes made during this period will become effective Jan. 1.