Medicare offers prescription drug insurance to all Medicare beneficiaries, regardless of income or health. Medicare Part D plans cover generic and brand-name prescription drugs. Private insurance companies sell the plans, which require monthly premiums, co-pays, and/or deductibles.
Part D coverage is available through “stand-alone” prescription drug plans (PDPs) that cover drugs only, as well as from Medicare Advantage with Prescription Drug (MAPD) plans that combine health and drug coverage.
Medicare Part D is like all insurance. It covers you if you need it now, and it protects you against future prescription costs, even if your drug needs change. If you do not enroll in Part D when you are first eligible, you may face a late-enrollment penalty later.
If you already have prescription coverage through an employer, a union, or a government agency (such as Veterans Affairs), you will want to stay with your existing plan if the drug benefits are “creditable” – as good as or better than Medicare’s standard Part D benefit. If you do not have a letter telling you whether your coverage is creditable, contact your benefits administrator and request one. If you do have a letter, keep it.
You will face a penalty if you are eligible for Part D but not enrolled in creditable drug coverage. The penalty amount is 1 percent of the Part D National Base Beneficiary Premium for every month you did not have creditable prescription drug coverage, but could have. If you have other drug coverage, that plan’s benefits administrator must issue a letter stating whether your coverage is as good as or better than Medicare’s basic PDP benefit.
Plans change every year. Medicare recommends that you review your prescription drug plan each fall. You may join, drop, or switch plans during the Annual Enrollment Period, from Oct. 15 to Dec. 7. To switch plans just enroll in a new PDP or MAPD. You will automatically be dropped from your previous plan when you enroll in a new one. You do not need to take any other action to end your prior plan.
If you take more than one enrollment action during the fall Annual Enrollment Period (AEP), the last action received by Medicare before the period closes is the one that will become effective.
Do not make more than one enrollment action on the same day.
If you move permanently, you must enroll in a new plan in your new state, even if you are enrolled in a national plan.
Each Part D plan has a list of prescription drugs it covers—also known as a “formulary.” Plans differ by formularies, rules governing access, and costs. Here are some common restrictions and limitations:
- Prior authorization: Your doctor must contact the plan and request authorization to write the prescription for the drug or the plan will not cover its share of the cost. This usually applies to non-preferred or very expensive drugs.
- Quantity limits: For cost or safety reasons, some plans may limit the quantity of drugs that they cover over a period of time. If you require more than the allowed amount, your doctor must submit proof that it is medically necessary and the plan may grant an “exception” to the limit.
- Step therapy: The plan requires that you must first try certain less-expensive drugs on its formulary before you can get a more expensive brand-name drug covered. If you have previously tried the similar drug and it didn’t work, or if your doctor believes because of your medical condition it is medically necessary for you to be on the drug, the doctor can contact the plan to request an “exception.” If the plan approves the request, then the drug will be covered.
Picking a plan with the fewest or no restrictions—even if you end up paying a somewhat higher premium—may be a good choice. It will lessen the amount of delay and paperwork to receive your preferred drugs.
The list below contains the highest rated Medicare Part D prescription drug plans in the state of Oregon. 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.