Prescription Plans

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Prescription Plans

Any HMO, PPO, POS or other group system may include prescription plans as a benefit reducing the cost of prescription drugs for the member. A big organization usually contracts a prescription drug vendor that works with pharmacies across the country. The pharmacies produce huge quantities of prescription drugs making discount offers easy.

Medicare prescription drug plan covers both brand name and generic prescription drugs at participating pharmacies in your area. It provides protection for people who have to pay extremely high drug costs. The plan was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and its benefit began on January 1, 2006. It is not part of the original Medicare program, which includes Part A for hospital care Part B for physician, home health and medical equipment care. It is instead administered by private insurance plans that will be reimbursed by the Centers for Medicare and Medicaid Services (CMS).

In order to be eligible for this plan, income and resources, health status or current prescription costs have no role to play as everyone with Medicare can join this program.
Beneficiaries can get the Medicare Drug plan through two types of private plans: they can join a Prescription Drug Plan (PDP) for drug coverage only or they can join a Medicare Advantage plan (MA) that covers prescriptions drugs (MA-PD). The drug plans will use a system in which lower cost drugs are to be assigned to lower tiers and thus are easier to prescribe.

For getting Medicare prescription drug coverage, the period of signing up is from November 15, 2006 to December 31, 2006. Your coverage begins on January 1, 2007. In case you fail to sign up when you are first eligible, you may pay a penalty. The next opportunity of signing up will be from November 15, 2007 to December 31, 2007. If you enroll by December 8, 2006, you can use your coverage as soon as you need it after it starts.

Your decision about Medicare prescription drug coverage will depend on the kind of health care coverage you are now having. You can receive Medicare prescription drug coverage by joining a Medicare prescription drug plan or joining a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage. Regardless of the plan you choose, Medicare drug coverage will cover for brand name and generic drugs at pharmacies that will be convenient for you.

If you decide to join the Medicare prescription drugs plan, you will be required to pay a monthly premium, which varies by plan, and a yearly deductible. You will also have to pay a part of the cost of your prescriptions, including a co-payment or coinsurance. Costs will differ with different drug plans. There are some plans that may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you are entitled to receive extra help, you may not have to pay a premium or deductible.

The advantage of Medicare prescription drug plan is that it can protect you from unexpected drug expenses. It makes sense if you join this plan even if you do not use a lot of prescription drugs because as we begin to grow older, we require prescription drugs to stay healthy. For those with limited income and resources, Medicare will pay for almost all of their prescription drug costs.

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