Type of Plans

The Medicare Prescription Drug coverage is an insurance program, with two types of participating insurance companies: (1) private insurance prescription drug plans (PDPs) and (2) Medicare Advantage prescription drug plans (MA-PDs), which are managed care companies offering other health services and prescription drugs (this is also known as Medicare Part C, or Medicare Plus Choice).

If your loved one is currently in a Medicare Advantage managed care plan, you will need to choose a plan linked to the managed care plan. If your loved one currently has private health insurance, you will choose a plan in the private insurance drug plan. If your loved one already has prescription drug coverage through a Medicare private health plan or an employer, please check with the current plan to see if this coverage is changing.

You will be able to choose one plan and enroll to get coverage from that plan. Plans will decide what drugs they will cover. The list of the covered drugs is called a “formulary”. Each plan has its own formulary. Formularies often divide drugs into tiers. First-tier drugs are the preferred drugs and will therefore have the lowest co-payment. Second-tier drugs will have a slightly higher co-payment, and third-tier drugs an even higher co-payment. It is best to select a plan whose formulary covers most or all of your drugs. If that is not possible, then consider talking with your doctor or pharmacist about switching drugs to the “covered” drugs of the selected plan.

If you loved one is receiving prescription drug coverage through Military retiree benefits (TRICARE), Veteran benefits (VA), or Federal employee retiree benefits (FEHBP), the Medicare Website says:

• It will almost always be to your advantage to keep your current coverage without any changes. However, if you have limited income and resources, you may qualify for extra help from Medicare. If you decide to make changes to your current coverage, you should first contact your benefits administrator or your FEHBP insurer.
• If you lose your TRICARE, VA, or FEHBP coverage and join a Medicare drug plan after May 15, 2006, in most cases you won’t have to pay a penalty, as long as you join within 63 days of losing your TRICARE, VA, or FEHBP coverage.