Whether you’re a healthcare provider, patient or vendor, dealing with Medicare can be difficult. Knowing the facts and enrollment dates can make navigating this complicated system a bit easier.
There are four parts to Medicare Coverage:
Part A: Covers hospital stays, skilled nursing care, nursing home stays, hospice and home health
Part B: Covers certain doctors’ visits, outpatient care, medical supplies, and preventative services
Part C: Also called the “Medicare Advantage Plans,” in which private companies contracted with Medicare provide you A, B, and D coverage. These plans are like HMO or PPO’s and your choices of physicians and locations may be limited.
Part D: Covers your prescription drugs
Medicare Part D Open Enrollment 2017 is
October 15 – December 7, 2016.
If you turned 65 in the past year or need to change your Part D plan, this is the time to enroll.
Each prescription drug plan has a formulary, which is a list of drugs that they will cover. These drugs may be placed on different tiers, which can determine how much the drug will cost you. A lower tier drug is usually the least expensive.
Most Medicare plans have a coverage gap, also known as the “donut hole.” You enter the donut hole when you’ve reached the full amount that your plan initially covers. Once that happens, you’re required to pay the full cost of the drug you until you reach a certain limit set by your plan. After that, “catastrophic coverage” kicks in, and most plans resume covering the majority of the drug costs.
The best method to determine which plan is best for you is to visit www.Medicare.gov and select “Choose a Drug Plan.” You can enter all of your prescription drugs and dosages and the site will recommend the best plans for you. You may also review total monthly and annual costs and see what rating is given to each plan. Going through this website may take some time, but it could potentially save you hundreds of dollars each year.
In order to make informed choices during the open enrollment period, you must have a good understanding of what Medicare covers and which prescription drug plans are best for you. At Guardian Pharmacy Atlanta, we accept all major Medicare Part D plans, and we are happy to answer questions for you regarding coverage. We have an expert billing department that is very helpful if you are having trouble understanding why a drug is covered or not covered.
For general Medicare questions, you may call our consultant pharmacist, Lori Newcomb, at (404) 309-4958. If you have specific questions about drug costs in your plan, please call our billing department at (770) 635-3301.