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Coordinating Medicare Part D with Other Types of Coverage

Written by Evens Stevenson

The older that you get, the higher the chance is that you have at least one prescription that you take. The majority of Medicare enrollees have multiple medications that they get filled every month. Depending on how specialized and the number of medications, these prescriptions can add up to thousands of dollars every year, which can be a senior’s budget under strain. There is nothing that you can do about the rising costs of prescriptions, and nobody should ever have to forego filling a prescription because of money, but there are some ways that you can offset the heavy price tags that those medications have.

Having coverage through Medicare Part D can help to defray the cost of prescription drugs for many of Medicare’s enrollees. While this important coverage works well on its Coordinating Part D with other types of coverageown, there are a number of Medicare participants who also have other healthcare coverage. Because of that, Part D benefits can be coordinated to work with other insurance benefits.

It’s vital that you understand how all of your insurance coverage is going to work with your Part D coverage. Any confusion or misunderstandings could lead to losing coverage, or gaps in your coverage that leaves you paying for prescription costs out-of-pocket.

Employer or Union Healthcare Coverage

For those who have health insurance through either a current employer or a union, Medicare will work with you in order to inform you of whether or not your prescription drug coverage is considered to be creditable. It is also a good idea to discuss your coverage situation with your benefits plan administrator at your place of employment. Once you join Part D, you or any of your dependent could lose the coverage from your employer or union health. It’s important that you understand how the two will interact before making any changes to your health care.

Health Insurance Marketplace

Recently, many individuals and families have purchased their health insurance through the health insurance marketplace. All of the private insurance companies that offer prescription drug coverage are required to determine whether their prescription drug coverage is creditable each year and to let their customers know their determination in writing.

The types of insurance that are considered to be creditable coverage include Veterans’ benefits, Federal Employee Health Benefits, TRICARE (military health benefits), and Indian Health Services.

It is important to note that many of the benefits may not be duplicated. For example, you may be eligible to obtain prescription coverage through the VA program, and you may also join a Medicare Part D plan. However, you may not use both coverages for the same prescription medication at the same time.

Medicare Supplement Insurance (Medigap)

Today, Medicare Supplement insurance is no longer allowed to be sold with prescription drug coverage. However, anyone who already owns a Medicare Supplement plan with prescription drug coverage is allowed to keep it. In this case, if you purchase a Medicare Part D plan, your Medicare Supplement plan must then remove the prescription drug coverage, and then correspondingly adjust your policy’s premiums.  If you would like to know more information on Medicare supplement Plan F, we can certainly help you make an informed decision. While these Medigap policies don’t provide any additional prescription coverage, they are still beneficial tools for protecting yourself from expensive medical bills that could drain your savings otherwise.

There are several health care expenses that Medicare doesn’t pay for, and that your other coverage might not pay for either, which could leave you with hundreds or thousands of dollars out-of-pocket.

Medicaid

Typically, for those who are covered by Medicaid, the cost of prescription drugs are covered by Medicare. Therefore, you will need to join a Medicare Part D plan. In most instances, you will be required to pay a small amount for your covered prescriptions. If, however, you have full Medicaid coverage and you reside in a skilled nursing home facility, then you will pay nothing for your covered prescription medications.

Supplemental Security Income (SSI)

If you receive benefits from SSI, or if you have help from your state Medicaid program with paying for your Medicare premiums, then you will be required to obtain a Medicare Part D prescription plan in order to obtain your medications. In this case, you will typically automatically qualify for the Extra Help program for the cost of your prescriptions.

State Pharmaceutical Assistance Program (SPAP)

SPAP is a great way to offset the costs of prescription drugs for those that wouldn’t be able to afford the expense otherwise. Each State has different requirements and each program interacts with Part D differently. For those who receive assistance from their State Pharmaceutical Assistance Program, they may be able to obtain some additional coverage when they join a Medicare Part D prescription drug plan. There are also some states that have a separate program that helps with prescriptions. For state specific information, it is important to contact your state’s SPAP program directly.

These are only a few of the possible coverage that you could encounter that work with Part D. As you can see, it can be confusing trying to understand how your Medicare coverage will work with other programs. If you have any questions about your Part D coverage or any other health insurance coverage, please feel free to call one of our agents today. We would be happy to answer any of those questions for you and ensure that you’re getting the coverage that you deserve.

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