October 6, 2016
If you’re a Medicare beneficiary living in Louisiana, you can get help paying for your prescription drug expenses through the Medicare Part D program. Under the Medicare Part D program, private insurance companies contract with Medicare to provide beneficiaries prescription drug coverage in Louisiana and throughout the United States. Typically stand-alone Medicare Part D Prescription Drug Plans in Louisiana include a monthly premium, an annual deductible, copayment and coinsurance in their prescription drug benefits. Stand-alone Medicare Part D Prescription Drug Plans in Louisiana may have different costs, depending on where you reside in the state and the prescription drug benefits offered by the plan you choose. You can learn more about Medicare prescription drug coverage in Louisiana and get help choosing a plan that works for you.
If you’re a Medicare beneficiary in Louisiana, you may be receiving health coverage through Original Medicare (which includes Part A and Part B), or a Medicare Advantage (Medicare Part C) plan that covers health benefits only. Neither of these Medicare insurance options typically provides prescription drug coverage except during an inpatient hospital stay. However, Medicare prescription drug coverage is available from stand-alone Medicare Part D Prescription Drug Plans, which are offered by private insurance companies contracted with Medicare. These plans can work alongside your Original Medicare or Medicare Advantage plan coverage. (You cannot have Medicare prescription drug coverage from both a Medicare Advantage Prescription Drug plan and a stand-alone Part D Prescription Drug Plan simultaneously.)
Each stand-alone Medicare Part D Prescription Drug Plan in Louisiana has a list of covered prescription drugs called a formulary. Often plans divide their formularies of covered prescription drugs into tiers (or categories), with each tier having a distinct cost-share, which is the amount the plan member pays out-of-pocket for the medication. So, for example a stand-alone Medicare Prescription Drug Plan may have a generic and a brand name covered drug on two different tiers. Typically the generic medication is on a tier with a lower out-of-pocket cost than the brand name drug.
In Louisiana, as in the rest of the United States, stand-alone Medicare Part D Prescription Drug Plans generally allow you to choose between brand-name drugs and generic drugs. The Food and Drug Administration (FDA) describes generic drugs as using the same active ingredients as brand-name drugs, at the same strength, dosage, and with the same method of administration. The FDA requires generics to be tested as having the same results as brand-name drugs. Generic drugs often cost less than their brand-name equivalent, resulting in cost savings for Medicare beneficiaries.
You must be enrolled in Medicare Part A and/or Part B to enroll in a stand-alone Medicare Part D Prescription Drug Plan.
If you’re enrolled in Medicare due to a disability, you can enroll in a Medicare Part D Prescription Drug Plan in Louisiana from three months before until three months after your 25th month of disability. In most other instances, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan during your seven-month Medicare Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month.
Another time you can enroll in a stand-alone Medicare Part D Prescription Drug Plan is during the Annual Election Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7. You can switch Medicare Part D Prescription Drug Plans during this period, also.
You may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. If you disenroll from a Medicare Advantage Prescription Drug plan during this period and return to Original Medicare, you can add a stand-alone Medicare Part D Prescription Drug Plan through February 14.
The best time for you to enroll in a plan that provides Medicare Part D prescription drug coverage might be when you are first eligible for Medicare benefits. An exception to this general rule is a circumstance in which you already have prescription drug coverage through another insurance that is equivalent to Medicare Part D coverage. In this instance, you have creditable prescription drug coverage.
Be aware, however, that if you go without creditable drug coverage for 63 days or more after your Initial Enrollment Period ends, you may be liable for a late-enrollment penalty if you enroll in a Medicare Prescription Drug Plan later, and you will continue to pay this late-enrollment penalty for as long as you have Medicare Part D prescription coverage. The Medicare Part D late-enrollment penalty is calculated using 1% of the national base beneficiary premium and the number of full months you were eligible for Medicare Part D but didn’t enroll in a plan offering Medicare prescription coverage. This amount is then added to your Medicare Part D monthly premium. The national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
In Louisiana, as in the rest of the United States, you are required to reside in the service area of your chosen Medicare Part D Prescription Drug Plan. If you join a stand-alone Medicare Part D Prescription Drug Plan, you have to remain enrolled in Medicare and continue to pay any Part A or Part B premium you owe in addition to the premium you pay for your Medicare prescription drug benefits in order to keep your insurance coverage. You may be eligible for Extra Help paying some of your out-of-pocket expenses related to Medicare Part D prescription drug benefits.
You may have options in your choice of Medicare plans offering prescription drug coverage where you reside in Louisiana. The basic types of plan options for this coverage are:
When comparing Medicare plans offering prescription drug coverage in Louisiana, it’s a good idea to take into consideration your medications. You can learn whether your medications are on the plan’s formulary before you enroll. You can understand how much you will pay out-of-pocket for your medications by reviewing benefit plan features such as deductibles, copayments and coinsurance.
Once you have enrolled in a Medicare plan that offers prescription drug coverage, it’s wise to review your Medicare Part D plan each fall season to see what changes to your coverage, if any, will occur at the start of the new benefit year (January 1st). In Louisiana, as elsewhere in the United States, Medicare plans providing prescription drug coverage may change their premiums, copayments, deductibles, and drug formularies every year. Plans notify their members of their benefits for the forthcoming year and changes in current benefits in the Annual Notice of Change and Evidence of Coverage documents they mail to members the end of September. It is important for you to understand these changes and how they impact your coverage and costs so that you can make an informed decision about staying with your existing plan or changing to another plan available in the Louisiana parish where you reside.
Access the following resources for additional details about Medicare in Louisiana: