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Medicare Part D Coverage in Florida

Medicare Part A and Part B help lower your medical costs, but they do not reduce your prescription costs. If you are in the hospital and need medication, Medicare Part A may cover the expense. If you need medication to take home, though, you’ll need Medicare Part D coverage in Florida.

What Is Medicare Part D?

Medicare Part D is a separate insurance plan that you buy from an insurance agent, not the government. Medicare Part D only covers prescriptions, not medical care. It may cover some of the cost of your medications, but each plan covers different drugs. You’ll also find that each plan has a different premium and coverage amount.

If you take medications now, look for them on the insurance plan’s formulary list. If you do not find your specific medication, you may need a different plan. Each policy has to offer at least two choices for each category or class. For example, every insurance company must offer two medications for heart health.

If you don’t take medication now, consider the types you might take in the future. If you prefer generic drugs, you will want a plan that offers tiered pricing for generic and name-brand drugs. You may be able to find a plan that offers generic drugs with little to no co-pay. If you want only name-brand drugs, find a plan that offers low co-pays or co-insurance for them.

When Should You Enroll in Medicare Part D?

Ideally, you should enroll in Medicare Part D when you enroll in Part B. You are eligible for Medicare Part B and Part D three months before you turn 65 years old. You can enroll throughout your birthday month and for three months after it. After that time, you must wait for the Open Enrollment

Period, which occurs each year from October 15 to December 7.

However, if you wait until then to enroll, you may face a late-enrollment penalty. Medicare charges the penalty to any beneficiary who is without prescription coverage for 63 consecutive days. If you don’t have credible prescription coverage from an employer or union, consider a Medicare Part D plan.

If you don’t have credible coverage, Medicare calculates a penalty of 1 percent of the “national base beneficiary premium,” which for 2019 is $33.19. For example, if you do not have coverage for 48 months and enrolled during open enrollment for the 2019 year, you would pay 48 percent of $33.19 or $15.93 in penalty charges in addition to your Medicare Part D premium. Medicare rounds your premium to the nearest $0.10.

The Cost of Medicare Part D Coverage in Florida

Because you get Medicare Part D insurance from an independent agent, each plan has different costs. Before you choose a plan, you should know the following:

  • How much is the deductible? You’ll have to pay this amount out of pocket before your insurance will cover anything. Make sure you can afford the amount before choosing a plan; most plans have an annual deductible of $415.
  • How much is the co-pay? Some plans have a flat fee for every prescription. Make sure you can comfortably afford this amount.
  • How much is the co-insurance? You may owe a percentage of the medication’s cost. You’ll know the percentage upfront but not the cost of the actual medication.

Other Options for Prescription Coverage

If having three Medicare policies to manage and two premiums to pay is too much, you have another option. Medicare Advantage with prescription coverage can help. Like Medicare Part D, you get Medicare Advantage (Part C) policies from an independent insurance agent. You can shop around with different agents to find the plan that is right for you.

Just like with Medicare Part D coverage in Florida, make sure you look closely at the plan and consult the formulary list. Does it include the medications that you take now? What is the coverage for generic and name-brand drugs? Do you know the co-pay or co-insurance amounts? Make sure you can afford the amounts before choosing the plan.

Medicare Part D coverage in Florida can help make your prescriptions more affordable. Even if you don’t take medications now, consider buying a plan. You can find a low-premium plan that offers basic coverage for now. This allows you to avoid the late-enrollment penalty. Should you need greater coverage in the future, you can change plans during Open Enrollment.

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