How To Get Prescription Coverage With Medicare

Published on October 13, 2021

The cost of medication is a hot-button topic in the news. Everyone has heard stories of seniors skipping days on their medication because they cannot afford to pay for it every month. The issue’s importance is difficult to exaggerate, as 89% of seniors report taking at least one prescription medication. While the cost of some generic medications may be easier to handle, seniors are leery of any area that could leave them exposed to a significant unexpected expense. For retired clients, full prescription drug benefits are critical for protecting their nest egg.

Since most seniors have Medicare, they have two options for obtaining drug coverage: purchase prescription coverage through one of the Medicare prescription drug plans (known as Medicare Part D) or a Medicare Advantage plan that covers prescriptions. 

Read on to learn more about these two options and how they work to keep seniors covered.

Prescription Drug Coverage Through Medicare Part D

Medicare enrollees have the option to elect the three parts of Original Medicare: Part A for hospitalizations, Part B for office visits, and Part D for prescription drugs. With the exception of diabetic supplies, Part A and Part B do not offer prescription coverage. That means any senior who wants drug coverage would need to enroll in a Medicare Part D plan. 

Medicare Part D plans are offered through private insurance companies. There are no standardized plan options for Part D, unlike Medigap plans, so each plan will have different benefits. Enrollees pay a monthly premium for their Part D coverage, which varies depending on the plan they choose. This premium is in addition to their premiums for Medicare Part B coverage and their Medigap plan.

Seniors must be enrolled in both Parts A and B to enroll in Part D coverage.

Prescription Drug Coverage Through a Medicare Advantage Plan

Prescription drug coverage is also available for seniors enrolled in Medicare Advantage plans. Medicare Advantage plans replace the coverage of Original Medicare with a plan offered through a private insurance company. While most Medicare Advantage plans include drug coverage, a few do not, so agents should verify whether the client is looking for drug coverage before recommending an option.

Prescription coverage through a Medicare Advantage plan will have different benefits depending on the plan the client selects. Because the prescription benefit is included in the rest of the plan, they would not have a separate or additional monthly premium for their coverage.

How Do Medicare Part D and Medicare Advantage Plans Work Together?

Because the cost of some medications is substantial even after insurance, clients may ask if they can get a Medicare Part D plan to use as a secondary coverage after their Medicare Advantage plan. Unfortunately, this is not an option.

Seniors enrolled in a Medicare Advantage plan cannot also enroll in Medicare Part D coverage, even if their Medicare Advantage plan does not offer prescription benefits. If a Medicare Advantage enrollee does enroll in a Medicare Part D plan, they will automatically be disenrolled from their Medicare Advantage plan and placed back on Original Medicare. Because of that fact, Medicare sales agents are not allowed to sell a Medicare Part D plan to a Medicare Advantage member unless the member is moving back to Original Medicare. If you have a Medicare Advantage client who expresses interest in a Medicare Part D plan, be sure to explain that those plans are incompatible and that signing up for a Part D plan will disenroll them from their current coverage.

Choosing the Right Option

When reviewing Medicare prescription benefit options, agents should use the cost estimation tools from carriers to compare the cost of their client’s medications. Ask your clients to provide the names and dosages for the medicines they take before your appointment and check their coverage with different plans. With the proper research, you can be confident in your plan recommendations.

Final Thoughts

Prescription benefits are the part of health coverage people interact with most, and this fact is particularly true for senior clients. By becoming familiar with the drug benefit options available, agents can ensure their client’s medications are affordable and accessible.

How Do I Learn More?

To learn more about Medicare prescription benefits, visit American Senior Benefits. You can find tips and advice to help you create a long and rewarding career.

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