Order photos

Make the most of Medicare’s drug coverage

by | Jul 19, 2017 | Opinion

By Bob Moos

Southwest public affairs officer for the U.S. Centers for Medicare and Medicaid Services

Medicare offers prescription drug coverage to everyone with Medicare.

It’s a good deal. Medicare subsidizes the outpatient drug benefit, generally paying about 75 percent of the program’s costs. Unless you already have comparable drug coverage through another source, you should consider getting it when you sign up for Medicare’s health care coverage at 65.

There are two ways to get drug coverage. If you’re in Medicare’s traditional fee-for-service program, you can purchase a “stand-alone” drug plan from an insurance company. Or, if you decide to buy a private Medicare Advantage health plan, you can choose one that includes drug coverage.

To find the “stand-alone” drug plans and the Medicare Advantage health plans with drug coverage available in your area, visit Medicare’s “plan finder” at www.medicare.gov/find-a-plan. You can also call Texas’ Health Information Counseling and Advocacy Program for help at 1-800-252-9240.

You’ll see there are significant differences in premiums and deductibles, in the co-payments the plans charge, in the particular drugs they cover and in the pharmacies they use. That’s why it’s important to look at your prescriptions and individual circumstances when comparing plans.

Ask yourself: Which plans cover the drugs I take? Which plan gives me the best overall price on all my drugs? Which plans allow me to use the pharmacy I want? Which plans let me get drugs through the mail? What are the plans’ quality ratings, such as for customer service?

You’ll discover that many plans place drugs into different “tiers.” The higher the tier, the greater your share of the cost will usually be. If you find that a prescription of yours is in a higher tier, you may want to ask your doctor whether there’s a drug in a lower tier that would work as well.

You may also encounter plans that follow “step therapy.” That means you must first try a less-expensive drug that’s been proven effective for most people with your condition before you can move up to a costlier drug. However, your doctor can request an exception if the costlier drug is medically necessary.

Medicare drug coverage is just like other kinds of insurance – you buy it to protect yourself if and when you need it. Even if you’re not on any prescriptions now, enrolling in a drug plan with a low premium guarantees you’ll have coverage should your health decline and you require medication.

After you pick a plan that meets your needs, call the company offering it and ask how to join. You may be able to join online, by phone or by paper application. Don’t be alarmed when you’re asked to provide the number on your Medicare card during the enrollment process. In this case, it’s OK.

The plan that’s best for you this year may not be the best next year. If so, you can switch to another plan between Oct. 15 and Dec. 7 each year. Indeed, it’s smart to check all your options every fall to make sure you have the plan that best fits your needs and pocketbook. Your new coverage then begins on Jan. 1.

If you’re having difficulty affording medications, you may qualify for the government’s “extra help” program. Your annual income can’t be more than $18,090 if you’re single or $24,360 if you’re married. Also, your resources can’t exceed $13,820 if you’re single or $27,600 if you’re married.

Generally, you’ll pay no more than $3.30 for each generic drug and $8.25 for each brand-name prescription in 2017. Thirty-five percent of Texans with a Medicare drug plan get extra help. To apply, visit the Social Security website, at www.socialsecurity.gov/i1020, or call Social Security at 1-800-772-1213.

People with Medicare have saved hundreds or even thousands of dollars each year thanks to their drug coverage. Be sure to make the most of yours.

For more stories like this subscribe to our print or e-edition.

Subscribe Love

0 Comments

Related News

Hold, please

Hold, please

It appears that telephone landlines may be on their way out. CNN Business reported that recently, AT&T applied for a waiver in the state of California to stop servicing traditional landlines. Both AT&T and Verizon have both said they want to move away from...

read more
Dewey or don’t we?

Dewey or don’t we?

On Christmas Eve 2008, there were just three of us working in the office. Well, technically, there was one of us working, the other two were there. A couple of the young ladies on staff either didn’t have enough vacation time built up or they were saving it for...

read more
A range of options

A range of options

My great grandparents lived on a homestead. They cooked on a wood stove. Most of us today have no idea how good we’ve got it. For my great grandparents’ generation, remodeling the kitchen meant picking a different place to stack the wood. By John Moore For more on...

read more
A word from our sponsors

A word from our sponsors

Commercials used to be great. They used to be an art form. They used to be fun. Today’s advertising is boring in comparison. Television commercials were something to which I looked forward when I was a kid. Some were better developed and more interesting than the...

read more
On the road again

On the road again

We often hear someone say they just want to leave the world a better place than they found it. That’s a great goal, but rarely is it the case. Unless you were Charles Kuralt. For those of us who grew up during his time on the CBS News segment, On The...

read more
The Walking Dad

The Walking Dad

It's obvious that I have to wait to die until after everyone else in my home goes. Otherwise, every light in the house will be left on for all of eternity. My dad used to say that I could leave on all of the lights whenever I started paying the bills. By John Moore...

read more
Small town living: some leave, some come back

Small town living: some leave, some come back

You learn things when you grow up in a small town. Things you don’t learn if you grow up anywhere else. Things that are special. I was born in a small town. But I didn’t stay. I left for the same reasons other folks leave their hometown. Education, better jobs, and...

read more
There’s ‘snow’ ice cream quite like it!

There’s ‘snow’ ice cream quite like it!

It didn’t snow much in Ashdown, Arkansas in the 1960s. It doesn’t snow there much now. But when it did, and when it does, kids there know exactly what to do. Beg their moms to make snow ice cream. By John Moore For more on this story see the December 21, 2023 print,...

read more
Sears catalog was ‘our’ Amazon in the 1950s and 60s

Sears catalog was ‘our’ Amazon in the 1950s and 60s

As a young kid, I thought that every family did exactly the same things ours did. That included what and how we did Christmas. Turned out, there were two ways to approach collecting your loot. That is to say, seeing what Santa brought. One, which was more traditional,...

read more
Former bridge brought fear to travelers

Former bridge brought fear to travelers

When you first learn to drive, there are a few things that are, shall we say, intimidating. For me, there was parallel parking and changing lanes at high speeds. Both of which were challenging in a 1971 Buick Electra 225 Limited, which was one of Detroit’s longer...

read more
Subscribe Love