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Medicare Part D Supplemental Insurance

Medicare Part D supplemental insurance helps you pay for prescription drugs, which are not covered under your original policy. Since prescription benefits are not encompassed in your basic coverage, you have two options for covering these needs. One option is a Medicare Advantage plan, or MA, which takes over your original policy and bundles all your services under a single private network. This bundling has led some people to call MA plans Part C. Under an MA, you must see health care providers that are members of your network. Your other option for Medicare Part D supplemental insurance is a separate, private policy just for Part D expenses. This alternative allows you to keep your regular insurance, while simply adding a component for your prescription drug needs. There are advantages and disadvantages to both plans.

Medicare Part D Basics

To understand your options for Medicare Part D supplemental insurance, it helps to understand how your original plan works. Once you reach the age of 65, you are entitled to enroll in Medicare. Your original policy typically involves two parts, "A" and "B." Most of your long-term services, like inpatient hospital care, skilled nursing facility, hospice care and home health care services, are covered by "A." Other medically necessary services like regular doctors' visits, outpatient hospital care, emergency room care and preventative services like flu shots are covered under "B." Prescription drug services are not included in "A" or "B," which is why seniors need a separate plan.You can purchase Part D supplemental insurance once you have enrolled in both parts of original Medicare.

Choosing an Advantage Plan

The benefit of an Advantage Plan is simplicity. With a single plan for all your medical needs, you only need to work with one provider and make one monthly payment aside from your regular "B" premium. The downside to an MA is restrictiveness and, in many cases, expense. Since you effectively join a private network, you must work with prescription drug providers who are also members of your Advantage Plan. This means that you might not be able to use your regular pharmacy if it is out of your network. Another disadvantage of Advantage Plans is the risk of getting dropped should your network choose to stop coverage in your regional area. This decision can occur at any time and is not related to any individual policy holder.

Choosing an Independent Plan

Under a supplemental Part D policy with an independent company, you enroll in a private plan that only encompasses your prescription drug needs. Your options will depend on the state that you live in. There are several online tools available that offer medicare supplemental insurance leads that can help you find the best stand-alone Medicare Part D supplemental insurance policy for you. Independent supplemental prescription insurance companies might have a few rules of which you should be aware before enrolling in one. If your company requires prior authorization, you or the doctor who prescribed a particular drug may need to prove that the drug is medically necessary before your Medicare Part D supplemental insurance will cover it.

Another common stipulation with many supplemental prescription plans is called a quantity limit. This stipulation restricts how much of a particular medication you can receive at one time. A final stipulation that only applies to some insurance providers is called "step therapy." This stipulation requires that seniors try one or more generic drugs at a lower price before their supplemental prescription insurance will cover the name-brand prescribed drug. Under most private Medicare D plans, these restrictions can be waived with a request for an exemption.

A few important deadlines apply to Medicare Part D supplemental insurance that can involve heavy fees if missed. Traditionally, you must enroll in a supplemental prescription insurance policy during the seven month window starting three months before you turn 65 and ending four months after your birthday. If you miss this window, you will have to pay a late enrollment penalty. You may also have to pay a penalty if you go more than 63 days in a row without a prescription drug plan. Your actual penalty price depends on how long you go without Medicare Part D supplemental insurance. Keeping Part D coverage on your radar as you start to investigate Medicare can help you avoid these penalties.

Medicare Part D supplemental insurance can seem confusing at first, but researching local providers can help you understand what services are available to you and what your monthly premium is likely to be. Online research can also help you understand what drugs are likely to be covered and what stipulations might apply to your prescriptions. Comparing your options online before purchasing a policy can help you choose a Medicare Part D supplemental insurance policy that fits all your needs at a price that fits your budget.


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