Medicare offers prescription drug coverage (Part D) for everyone with Medicare. You must purchase a Medicare drug coverage policy or plan from a company approved by Medicare. Each plan can vary in cost and drugs covered.
There are two ways to get Medicare prescription drug coverage:
- Join a Stand Alone Medicare Prescription Drug Plan that adds drug coverage to the Original Medicare Plan.
- Join a Medicare Advantage that includes prescription drug coverage as part of the plan. These plans (called “MAPDs”) provide all of your Medicare coverage, including prescription drugs.
Medicare drug plans cover both generic and brand-name drugs. Each plan has a different formulary, which is a list of drugs covered by the plan. This list must always meet Medicare’s minimum requirements, but it does not have to include all prescription drugs.
In some circumstances, with Medicare’s approval, plans can change their formulary during the year. Two such circumstances include: if a new generic version of a covered brand-name drug becomes available; or if new FDA or clinical information shows a drug to be unsafe. In general, however, plans cannot discontinue or reduce the coverage of a drug you are currently taking. If a formulary change is made that affects you, the plan must let you know at least 60 days before the change takes place.
If your doctor thinks you need a drug that is not on the list or determines a formulary change would adversely affect you, you or your doctor can request an exception from the insurance company. If the company denies the request, you can appeal the decision.
For people who are new to Medicare, the Initial Enrollment Period (IEP) for Part D lasts for seven months: beginning three months prior to the month you become eligible and ending three months after the month you become eligible. For example, if you turn 65 on September 13, your IEP begins June 1 and ends December 31, during which time you may enroll in a Medicare Part D or MAPD.
If you are enrolled in Medicare Part A or Part B and have not joined a Stand-Alone Medicare Prescription Drug Plan or MAPD plan, AND if you do not have creditable coverage for your prescriptions (coverage that is at least as good as the standard Part D benefit), your next opportunity to enroll in a PDP is during the Annual Election Period (AEP).
If you do not join a plan and do not have creditable coverage (coverage as good as what Medicare prescription insurance offers) for your drugs when you later enroll for a plan, you may incur a penalty of 1% of the national average premium for every month you were eligible and did not sign up.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Idaho. It is for informational purposes only and some listings may be inaccurate or missing. The list was provided by the Centers for Medicare and Medicaid Services (CMS), but due to the variance in plans based on county, city, and region, some options may not be available in your location.