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How to Get Coverage for Your Medications

If you are like many Americans, then you are probably taking one or more prescription drugs to treat any lingering health issues.  The Mayo Clinic recently published a study that suggests that 70 percent of the country takes one or more medications each year, and this number is rising.  The entire U.S. population of more than 310 million spent almost $425 million on prescription medications in 2016, which was 12 percent increase over the previous year. By 2020, the country could be spending from $610 to $640 million on drugs annually.

Whether you are spending a few bucks or thousands of dollars annually on your medical pharmaceuticals, you probably want the best deal possible for each dollar spent. You can stretch your medication dollars in a number of ways including Medicare Part D, Medicare Advantage plans or discount pharmacies.  It may take a little more effort to enroll in some of these programs, but the cost savings are well worth it.

Medicare Part D

As you approach retirement age of 65, you will want to look into Medicare, the government health insurance program for seniors. You should enroll in Medicare as soon as you turn 65, or you may be financially penalized for late enrollment. Once you sign up for Medicare Parts A and B (which cover inpatient and outpatient medical services), you will be given the option to enroll in the Medicare prescription drug benefit, also known as Medicare Part D. If you do not sign up for Medicare Part D at the appropriate time, you may be charged a 1 percent surcharge for late enrollment.

Medicare Part D was established in 2006 to help pay for prescription drugs for senior beneficiaries. Almost two-thirds of all Medicare enrollees also enroll in Medicare Part D or a Medicare Advantage plan with prescription drug benefits. You may choose from over 1,500 Medicare Part D plans available across the nation, but most regions have between 40 and 55 available plans. It cost $40 a month to enroll in Medicare Part D in 2013.

Under Medicare Part D in 2013, beneficiaries are limited to a deductible of only a few hundred dollars per year (in 2013, it was $325).  After the deductible is paid, beneficiaries must pay a 25 percent coinsurance on all prescription drugs, up to an annual total of $2,970.  Following this initial benefits limit, beneficiaries are then responsible for the full cost of drugs up to a limit of $4,750.  At this point, catastrophic benefits kick in and beneficiaries must pay 5 percent coinsurance, $2.65 for generics, or $6.60 for name brand drugs—whichever is greater. Every year, the benefits are adjusted by Medicare.


Medicare Advantage

Medicare Part C allows enrollees to obtain their Medicare benefits through a private insurer.  Also known as Medicare Advantage plans, Medicare Part C offers at least the same benefits as Parts A and B, and may include additional benefits like vision, dental and prescription drug coverage.  There are a wide variety of Medicare Advantage plans available, with most requiring an additional monthly premium ranging from zero up to a hundred dollars.

There are many pros and cons to a Medicare Advantage plan, largely depending on which particular plan you choose. Each plan has its own premiums, deductibles and out-of-pocket requirements which you should closely examine before making a decision. 

Luckily, most Medicare Advantage plans include prescription drug benefits, as Medicare Advantage enrollees are not allowed to also enroll in Medicare Part D.  According to the Kaiser Family Foundation about 82 percent of Medicare Advantage plans include drug benefits. However, you should investigate what drugs are covered under a prospective Medicare Advantage, as some plans are more comprehensive than others.

Bargain Hunting

If you are prescribed a medication by your doctor that isn’t covered by Medicare Part D or your Medicare Advantage plan, then you may need to do some shopping to find the best deal available.  You should begin by asking your doctor if the prescribed drug is the least expensive option.  Many physicians have relationships with drug companies, so they may naturally recommend the name brand version, but most will substitute the cheaper generic if asked.

Like most products, prescription drugs are cheaper when they are purchased in bulk. Therefore, you may be able to save some money if you can buy a 90 day supply instead of 30.  If your doctor is amenable to it, you may be able to get pills with double dosage—which tend to be cheaper—and then you can split them in half.  You may not wish to disclose this double dose strategy to your insurer, as some frown upon the practice.

You may also wish to look into discount pharmacies or drug programs.  Many pharmacies recognize that many Medicare beneficiaries may lose drug coverage when the benefits limit is reached, so they offer discounts to seniors caught in the “donut hole.”  You may need to go online or call around to find participating pharmacies.  You may also be able to add a 15 to 40 percent discount from your discount drug program.

Finally, there is the option of using giveaway programs from drug companies.  Many manufacturers have programs that provide free medications to a small number of consumers.  They typically don’t advertise these programs, so you may have to do some research to learn the details.  Among the most high profile is the Partnership for Prescription Assistance, which is supported by a coalition of major drug companies.

It is only natural that you want to get the medications that keep you healthy at the best possible rate.  The government, insurers and drug companies want to help you to get these life-saving treatments, which is why they have created programs like Medicare Part D, Medicare Advantage and other discount programs.  If you wish to learn more about these programs, including potential benefits and how to join, you may find many of the answers from the health insurance experts at Boost Health Insurance.

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