Medicare Plan D
Only life-saving drugs are covered and premiums and deductibles for generic drugs come at a cost.
Medicare Part D is only 50% subscribed due to confusion over eligibility and coverage.
The controversial Medicare Part D drug plan has had a very bumpy start and has recently issued an extension through March 31, 2006 for those who enrolled early and have had difficulty getting their medications covered.
Perk or Nightmare?
What was purported to be an added perk for Medicare beneficiaries has actually become a nightmare for some. Not all medications are covered, and the costs can be higher than some expected. As predicted, there have been many stumbling points.
More than 50% of those eligible to enroll have not. One of the biggest reasons why they haven't is that it is all too confusing.
The Medicare Prescription Drug Improvement and Modernization Act of 2003 officially went into effect on January 1, 2006. The initial enrollment period began In November 2005 and continues through May 15, 2006. Those who enroll after May 15 will be penalized with higher costs in premiums.
Only Medically Necessary Meds Are Covered
It is important to understand that not all medications are covered. Medicare rules state that only medically necessary drugs have to be covered. This means drugs that help to sustain your life. These drugs include drugs to treat cancer, diabetes, chronic heart and lung disease, HIV/AIDS, and convulsive diseases. Anti-depressants and anti-psychotic drugs are also covered.
Drugs that are not covered include those for anorexia, weight control (both weight loss and weight gain), barbiturates, benzodiazepines (for anxiety related disorders), prescription vitamins and minerals, and medications for cough or colds. No OTC (over the counter) drugs are covered.
Plans Vary in Cost of Drugs
Each plan sets the costs of the drugs by placing them into tiers. Plans vary in monthly premiums and amounts of deductibles and copays. Some plans only cover a drug in its generic form, and some will offer the brand name at a higher copay.
Compare Plans
To choose the plan that works for you, CMS (Centers for Medicare and Medicaid) offers a formulary checker. You can choose your State and then enter your drugs and see which plans cover those drugs. It will tell you if there are limitations on amounts and whether the plan requires prior authorization. You can also find out if your local pharmacy is a network provider under this plan.
If you need further assistance in choosing a drug plan, contact CMS. You may also wish to consult with your local pharmacist who knows the medications you take and has had experience with these plans.
Do Your Homework
Many of the stumbles in the early days of this plan have been related to medications which are not covered by a plan, and the copays. For those who were covered by Medicaid or other low income plans these higher costs are staggering.
Do your homework before you sign up for a plan. Be an informed consumer. If a drug is not covered, speak to your physician about changing to one that is covered.
For further help if you cannot afford medications contact the Social Security Administration at 1-800-772-1213 to apply for assistance.
