FINDING A PART D MEDICARE PLAN

How Do I Make Sure I Find a Plan That Meets My 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 you 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. Use this pre-made chart (PDF) to list all your prescription information.
     
  • 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 web tool to find out information about and 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 (copayments or coinsurance) for each drug I need? Certain drugs may have high coinsurance.

      • How much will I pay in monthly premiums and deductibles?

      • If a drug I take has a very high coinsurance, is there a drug I can take that will cost me less, such as a generic? (Ask your doctor.)

      • 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 (formulary) with different costs and restrictions and you will want to ask:

      • Does the plan cover all the medications I am taking? (Refer to your prescription list.)

      • Does the plan cover the most important medications I take? (Ask your doctor.)

      • If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)

      • 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 your doctor.)

    • Ask about your pharmacy network. You usually pay the full cost of non-covered drugs and prescriptions from out-of network pharmacies. PH patients should pay special attention to pharmacy network, as it is critical that you be able to receive your medications through specific specialty pharmacies.

      • 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 from October 15-December 7.

    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.
Contact us with insurance questions, success stories, suggestions, or requests to volunteer.


 

What is Medicare Part D?

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.

What PH-specific drugs does Part D Cover?

Part D includes coverage for most oral PH medications, including:

  • Adcirca®
  • Adempas®
  • Letairis®
  • Opsumit®
  • Orenitram®
  • Revatio® (Viagra)
  • Tracleer®
  • Veletri®

*Flolan®, Ventavis®, Remodulin® and Tyvaso® are generally covered under Medicare Part B because of the use of durable medical equipment when administered.

When can I enroll in Part D?

Enroll in or change your Medicare Part D and/or Medicare Advantage Plan during the Fall Open Enrollment Period (also known as the Annual Coordinated Election Period) from October 15 - December 7.

Enrollments and changes made during this period will become effective January 1.

The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

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NORD

The National Organization for Rare Disorders (NORD) awarded PHA the Abbey S. Meyers Leadership Award in 2012 for outstanding service to PHA members in advocacy, education and other key areas.