Medicare Part D
What is Medicare Part D?
Medicare Part D is Medicare’s prescription drug benefit that provides outpatient drug coverage. Part D is provided through private insurance companies contracted with the federal government.
If you want Part D coverage, you have to either buy a standalone plan or get it through a Medicare Advantage plan.
What Drugs are Covered?
Prescription Drug Plans and Medicare Advantage Prescription Drug Plans cover all vaccine drugs when necessary to prevent illness. Other than that, you will have a formulary unique to your plan that details what drugs are covered. So, before you choose a plan, you need to talk to a licensed Medicare specialist like the ones at AgentDavidCares.com to make sure all the drugs you require are covered with your plan.
What are the Different Plans?
Depending on your plan, this answer will differ. However, these are some drugs that will most likely not be covered under any prescription drug plan:
• Weight loss or weight gain drugs
• Any drugs for hair growth
• Fertility drugs
• Drugs for erectile dysfunction
• Any over-the-counter drugs
Also, if your Medicare Part A or B plan is going to foot the bill, Part D does not offer coverage.
You are Notified of Any Changes
You can rest assured that all Medicare Prescription Drug Plans are required to publish any changes to its formulary on the plan’s website. The insurance company must also tell you when drugs are removed from the Part D formulary.
All plans are restricted from making changes to the drugs provided and making price changes between the beginning of the annual election period until 60 days after coverage begins. The only exception is if the FDA determines a drug is unsafe or the manufacturer ceases production of the drug.
Also, any changes must include the name of the drugs removed, if the drug changes tiers, the reason for the change, alternate drugs available, any cost sharing, and exceptions available.
Your Rights to a Prescription Drug Plan
Once you purchase a prescription drug plan, you have the right to:
• Receive a written explanation from your plan about your benefits
• Ask for exceptions if a drug you need is not covered by your plan
• Ask for exceptions to waive coverage rules
• Ask for lower copayments for higher-cost drugs if you or your prescriber believe you can’t take lower-cost drugs for your condition
Don't Risk Getting the Wrong Coverage
Work with David!
I understand the Medicare enrollment process can be difficult to understand. This is why I strive to educate and empower my clients to make the right decisions for their individual health insurance coverage.
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I am a licensed Insurance Agent in any state I do business in
I am not an attorney, I do not give legal advice but I know some if you need one
I am not an accountant, I do not give tax advice but will direct you to talk to one and have some I can introduce
I am not a doctor, I do not give medical advice but I can help look up doctors in your network
I represent multiple carriers so I have more options for you
I mainly do virtual appointments, I live on top of a mountain in the middle of nowhere (about 45 minute to Crossville...you know, the BIG CITY ;)
Most policies are not guaranteed issue aka you have to apply and answer some questions
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We do not offer every plan available in your area. Currently we represent 8 organizations which offer 38 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options
Updated 10042024
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