Last Updated on
October 6, 2016
Medicare Part D in Missouri and the rest of the United States is a program where Medicare-approved private insurance companies offer Medicare plans that include prescription drug coverage and are designed to help Medicare beneficiaries pay for their prescription drug expenses. Costs for Medicare plans that include prescription drug coverage in Missouri vary depending on your particular location and zip code, but most require payment of a monthly premium, annual deductible, and copayments or coinsurance.
Medicare beneficiaries in Missouri receiving health coverage through Original Medicare, Part A and Part B may want to think about enrolling in a Medicare plan that includes prescription drug coverage. In Missouri, as in the rest of the United States, Medicare beneficiaries are required to reside in the service area of whichever Medicare plan that includes prescription drug coverage that they select.
Each Medicare plan that includes prescription drug coverage in Missouri has its own list of covered prescription drugs, called a formulary (which may change at any time; you will be notified when necessary). The formulary separates prescription drugs into different tiers (or categories), each with a different price point. The top tier lists higher-priced medications, while the lowest tier includes the least expensive prescription drugs. If your doctor decides that a prescription drug in a higher tier is medically necessary for your treatment, you or your doctor can ask your plan for a tiering exception and benefit from a lower copayment for your higher-tier medication.
In general, Medicare plans that include prescription drug coverage in Missouri allow you to choose between brand-name prescription drugs and generic prescription drugs. Generic prescription drugs, as defined by the Food and Drug Administration, use the same active ingredients as brand-name prescription drugs, at the same strength, dosage form, and with the same method of administration, and they are tested to have the same results. The difference for you is that generic prescription drugs often cost less than their brand-name counterparts, so you may end up paying a reduced amount for your medication. In case your generic prescription drug is not available, your prescription drug plan may allow you to substitute it with a similar generic prescription drug, resulting in lower out-of-pocket expenses, so be sure to discuss all prescription drug options with your doctor.
A good time to enroll in Medicare Part D in Missouri is 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. On the other hand, if you’re eligible for Medicare due to a disability, you can enroll in Medicare Part D in Missouri from three months before until three months after your 25th month of disability benefits. Understand that you must either have or be eligible to join Medicare Part A to enroll in Medicare Part D in Missouri.
Another time you can enroll in Medicare Part D in Missouri is during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. If you disenroll from Medicare Advantage during this period and return to Original Medicare, Part A and Part B, you can add stand-alone Medicare plan that includes prescription drug coverage through February 14 as well.
You may also sign up for Medicare Part D in Missouri during the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 each year. And you can switch Medicare Part D Prescription Drug Plans during the same period.
It’s important to keep in mind that if you go without creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty for as long as you remain enrolled in Medicare Part D. The 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. 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.
Also note that even if you enroll in a Medicare plan that includes prescription drug coverage, you have to remain enrolled in Medicare Part A, and pay any Part A premiums (if you’re not entitled to premium-free Medicare Part A coverage) to keep your health insurance coverage.
There are two types of Medicare plans that include prescription drug coverage in Missouri. A Medicare Part D Prescription Drug Plan is a stand-alone plan that Medicare beneficiaries may choose to enroll in, in addition to Original Medicare, Part A and Part B, to help cover costs for prescription drugs, while a Medicare Advantage Prescription Drug plan combines health and prescription drug coverage into a single plan, offering at least the same coverage as Original Medicare (except for hospice care, which Medicare Part A still provides). Medicare Advantage Prescription Drug plans often offer additional benefits as well, like vision, hearing, and dental, all for a single premium.
When comparing Medicare plans that include prescription drug coverage in Missouri, it’s always a good idea to take into consideration your individual prescription drug needs, since it’s your prescription drug costs, rather than your premium or deductible that often determines most of your out-of-pocket expenses.
It’s also smart to review your Medicare plan that includes prescription drug coverage at the end of every year to find out about any changes to your coverage. Medicare plans that include prescription drug coverage in Missouri and the rest of the United States are may change their premiums, copayments, deductibles, and prescription drug formularies (the plan will notify you when necessary) on an annual basis, which means that your present plan may not suit your prescription drug needs in the coming year. You may even want to shop for a new plan every year during the Annual Election Period.
Medicare plans that include prescription drug coverage have availability and costs vary by state.
For additional information about Medicare in Missouri, visit the following pages: