Medicare beneficiaries in Florida may have options when choosing prescription drug coverage. A stand-alone Medicare Part D Prescription Drug Plan is one such option. Costs associated with Medicare Prescription Drug Plans in Florida, as in other states, may vary among plans, but most require payment of a monthly premium, an annual deductible, and copayment or coinsurance.
Medicare prescription drug coverage is available through the Medicare Part D program. Under Part D, private insurance companies that contract with Medicare offer stand-alone Prescription Drug Plans, which are designed to help cover your medication costs. In Florida, as in other states, prescription drug coverage is optional, but be aware that Original Medicare (Part A and Part B) offers only limited prescription drug coverage, and doesn’t cover most medications you take at home.
Each Medicare Prescription Drug Plan has its own list of covered prescription drugs, called a formulary. Covered prescription drugs are sorted into different categories called tiers, each with a different cost. Drugs in the lowest tier usually cost the least, while drugs in the higher tier cost more. If your doctor or health provider decides you need a higher-tier drug to treat your health condition, you might be able to get it for a lower cost by requesting a formulary exception from your plan.
Formularies usually include both brand-name and generic prescription drugs. Many brand-name drugs have generic equivalents. The U.S. Food and Drug Administration defines brand-name drugs as those “marketed under a proprietary, trademark-protected name,” and generic drugs as medications equivalent to brand-name drugs in “dosage, safety, strength, how it is taken, quality, performance, and intended use.” Generic drugs tend to cost less than brand-name drugs and can result in significantly lower out-of-pocket expenses. If the generic version of your brand-name prescription drug is unavailable, there may be a similar generic drug that could work just as well for your health condition. Make sure you discuss all prescription drug options with your doctor.
Here are some rules to be aware of before enrolling in a Medicare Prescription Drug Plan in Florida (or any state):
In Florida, as in other states, you could be subject to a lifetime late-enrollment penalty for Medicare Part D if you don’t sign up during your Initial Enrollment Period and then add this coverage later on – the penalty could apply as long as you have prescription drug coverage. One way to avoid this penalty (even if you delay Part D enrollment) is to make sure you have continuous creditable drug coverage. This is coverage that pays, on average, at least as well as Medicare is expected to pay for standard drug coverage. If you go without creditable drug coverage for 63 days or more, you’re likely to face this penalty. The late enrollment penalty is calculated using 1% of the national base beneficiary premium ($34.10 in 2016) and the number of full months you were eligible for Part D but didn’t join. Medicare adds this amount to your Part D monthly premium. Remember that the national base beneficiary premium may increase each year, which means your late enrollment penalty may also increase.
It’s important for you to know that if you choose to enroll in a Medicare Prescription Drug Plan, you are still enrolled in Original Medicare and must continue paying your Medicare Part B premium so you won’t lose your health coverage.
If you’d like a different way to receive Medicare prescription drug coverage in Florida, you might consider a Medicare Advantage Prescription Drug plan. With this kind of plan, you get your Original Medicare, Part A and Part B, benefits through a private health insurer that contracts with Medicare. Hospice benefits are still covered directly under Part A and not through the Medicare Advantage plan.
A Medicare Advantage Prescription Drug plan combines health and prescription drug coverage into one private insurance policy, and sometimes includes additional benefits such as routine vision, hearing, and dental services, all in one plan.
If you decide to enroll in a Medicare Advantage Prescription Drug plan, remember that you need to be enrolled in Original Medicare, Part A and Part B. You’ll pay the plan’s premium (if it has one) in addition to your Original Medicare premium(s).
After reading all this information, how can you decide whether to add prescription drug coverage under Medicare Part D, and which plan to sign up for? You may want to consider these:
Medicare drug plan availability and costs vary. To start comparing plans in your area, just enter your zip code where indicated on this page; you can even enter your prescription medications to limit your search to plans that may cover them.
You can also view the following pages for more information on other types of Medicare coverage in Florida: