Medicare Part D Benefits
Navigating the alphabet soup of Medicare – with its various coverages like Part A, Part B, and Part D – can be quite overwhelming and confusing. However, understanding the complexities of Medicare Part D coverage can be particularly important for those living with Alzheimer’s and their caregivers.
We are currently witnessing a phase of remarkable discoveries in medications that aid in managing Alzheimer’s and potentially slowing its progression. As advancements in pharmacology continue to offer hope for those dealing with Alzheimer’s progression, being informed about your Medicare options becomes even more important.
LivWell Seniors is dedicated to helping you access all the resources necessary for smooth, efficient, and vital elder care. We encourage you to read this article from a valuable member of our Caring Network for a summary of Medicare Part D Benefits.
If the person with dementia has Medicare, then he or she can enroll in Medicare’s Part D prescription drug plan. Be sure to review Medicare Part D plans carefully regarding Alzheimer’s drug coverage.
Part D Basics
Medicare works with insurers and other private companies to offer different prescription drug plans that vary in cost and drug formularies. During the Medicare Part D annual open enrollment period (Oct. 15 – Dec. 7), Medicare beneficiaries can enroll in a drug plan. Beneficiaries already enrolled in a Part D drug plan can also change to a different plan during this period.
Key Things to Consider When Choosing a Part D Plan:
- Will the drug plan pay for all or most of the drugs you take now?
- Are your Alzheimer’s drugs on the formulary?
- Does the plan cover the doses of the drugs that you take?
- Do the plan’s rules limit coverage of your Alzheimer’s drugs and/or your more costly drugs by requiring “prior approval?”
- Do the plan’s rules require you to try a less expensive, similar drug (“step therapy”) before the plan will pay for your drug(s)?
- Are there limits on the number of pills that a prescription may cover (“quantity limits”) over a specific period of time?
- What will the plan cost you? Be sure to compare all of the costs for each plan, including the deductible, copayments and coinsurance, not just the amount of the monthly premiums.
- Is your local pharmacy in the plan’s pharmacy network? Depending on the plan, mail order may be an option, offer an incentive or be required to fill prescriptions.
Extra Help Paying for Prescription Drugs
Medicare beneficiaries who have limited income and resources may qualify for extra help paying for prescription drugs. The Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS) work together to provide this extra assistance.
- People with both Medicare and Medicaid (called “dual eligibles”) will automatically qualify for extra help.
- Other individuals may apply for extra help from the SSA. Apply online (ssa.gov) or call 800-772-1213 for a paper application or to make an appointment.