Last Updated on
October 6, 2016
Medicare Part D prescription drug benefit is designed to help Medicare beneficiaries cover prescription drug costs. As a Medicare beneficiary in Arkansas, you can receive this benefit by enrolling in a stand-alone Medicare Part D prescription drug plan (or PDP) or a Medicare Advantage Prescription Drug Plan. Each Medicare plan that includes prescription drug coverage in Arkansas has different costs, depending on your location and zip code, and may require you to pay a monthly premium, annual deductible, and copayment or coinsurance.
If you’re already enrolled or are eligible to enroll in Original Medicare, Part A and Part B, you may be able to sign up for a Medicare plan that includes prescription drug coverage in Arkansas. A stand-alone Medicare Part D Prescription Drug Plan may be available for Medicare beneficiaries who remain with Original Medicare. Or, if you choose Medicare Advantage, certain types of Medicare Advantage plans include prescription drug coverage (Medicare Advantage Prescription Drug plans).
Medicare plans that include prescription drug coverage in Arkansas each have their own list of covered prescription drugs (called a formulary). A formulary lists prescription drugs in different tiers (or categories), each with a different cost, with the lowest tier including the most affordable prescription drugs and the highest tier including the more expensive medications. (Note that a formulary may change at any time; the plan will notify you when necessary.) In certain cases, your doctor may determine that a prescription drug in a higher tier is medically necessary for your health condition instead of a similar prescription drug in a lower tier. If so, you or your doctor can ask your plan for a tiering exception, which may help you get a lower cost for the prescription drug.
Medicare plans that include prescription drug coverage in Arkansas may offer you the option to choose between brand-name prescription drugs and generic prescription drugs. The Food and Drug Administration (FDA) specifies that generic prescription drugs must have the same strength, dosage form, active ingredients, method of administration, and effectiveness as brand-name prescription drugs. But, as you probably know, generic prescription drugs can cost substantially less than their brand-name counterparts. If the generic version of your brand-name prescription drug is not available, you may be able to substitute it with a similar generic prescription drug, so be sure to discuss all generic prescription drug options with your doctor.
You must either have or be eligible for Medicare Part A and/or Medicare Part B in order to enroll in a Medicare plan that includes prescription drug coverage. You must also permanently reside in the appropriate service area of Arkansas for your plan. In Arkansas, like in other states, you can join a Medicare plan that includes prescription drug coverage during the three months before you turn 65, your birth month, and the three months after your 65th birthday month. This is the seven-month Medicare Initial Enrollment Period. If you’re enrolled in Medicare because of a disability, you can enroll in a Medicare plan that includes prescription drug coverage starting the three months before through the three months after your 25th month of disability.
You can also enroll in Medicare Part D during the Annual Election Period, which runs from October 15 to December 7, and you’re are also able to switch Medicare plans that include prescription drug coverage during that period. In addition, if you’re enrolled in a Medicare Advantage plan and decide to switch to Original Medicare, you can do so during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year. If you do so, you then have until February 14 if you want to add a stand-alone Medicare Part D Prescription Drug Plan to your health insurance coverage.
It’s important for you to remember that after your Initial Enrollment Period is over, if you remain without creditable prescription drug coverage for 63 days or more, you may be subject to a late-enrollment penalty for Medicare Part D. In Arkansas, as in the rest of the United States, the late-enrollment penalty is calculated using 1% of the national base beneficiary premium multiplied by the number of full months you were eligible to enroll in Medicare Part D but didn’t do so. This amount is then added to your Medicare Part D monthly premium for as long as you have Medicare Part D.
The national base beneficiary premium for Medicare Part D may increase each year, which means your late-enrollment penalty may also increase each year.
Various types of Medicare plans that include prescription drug coverage are available in Arkansas. A Medicare Advantage Prescription Drug plan is a stand-alone plan that beneficiaries generally get in addition to their Original Medicare coverage in order to receive help with prescription drug costs. A Medicare Advantage Prescription Drug plan, on the other hand, combines health and prescription drug coverage into one plan, offering at least the same coverage as Original Medicare, and sometimes additional benefits such as vision, hearing, and dental, all for a single premium.
When choosing a Medicare plan that includes prescription drug coverage , you may want to take into consideration your individual prescription drug needs. The costs of the prescription drugs you take could be the biggest determiner of your out-of-pocket expenses.
It may be a good idea to review the Medicare plans that offer prescription drug coverage offered in your area of Arkansas at the end of each year, in order to be aware of any changes to your coverage or costs. Medicare plans that include prescription drug coverage can change their premiums, copayments, deductibles, and prescription drug formularies every year–so the plan you’re enrolled in now may not be the right one for you in the future.
For more information about Medicare insurance plans in Arkansas, access the following resources: