October 6, 2016
Medicare Part D in Nebraska, as in the rest of the United States, is designed to help Medicare beneficiaries get coverage for their prescription drug costs. This type of Medicare plan that includes prescription drug coverage is offered by Medicare-approved private insurance companies, with varying costs for each plan, depending on the beneficiary’s location and zip code. Most Medicare plans that includes prescription drug coverage in Nebraska and throughout the U.S. require payment of a monthly premium, annual deductible, and copayments or coinsurance.
If you’re a Medicare beneficiary living in Nebraska, you may be receiving health coverage through Original Medicare, Part A and Part B. To get help paying for your prescription drug expenses, you may want to consider enrolling in Medicare Part D. Here’s a look at what Medicare Part D in Nebraska can offer.
Each Medicare plan that includes prescription drug coverage in Nebraska has a list of covered prescription drugs called a formulary. The formulary separates drugs into various tiers (or categories), each with a different cost. (A formulary may change at any time. You will be notified when necessary.) The top tier includes higher-priced medications, while the bottom tier lists the least expensive prescription drugs. If your physician or health-care provider decides that a prescription drug in a higher tier is medically necessary to treat your health condition instead of a similar prescription drug in a lower tier, you or your physician can ask your plan for a tiering exception to benefit from a lower copayment for a higher tier prescription drug.
In general, Medicare plans that include prescription drug coverage in Nebraska allow you to choose between brand-name prescription drugs and generic prescription drugs. Generic prescription drugs, as defined by the Food and Drug Administration, have the same active ingredients as brand-name prescription drugs, at the same strength and dosage and with the same method of administration, and generics are tested to have the same results as brand-name prescription drugs. The difference is that generic prescription drugs generally cost less than their brand-name counterparts. If a generic prescription drug is not available, your prescription drug plan may allow you to substitute it with a similar generic prescription drug instead of paying the higher price for the brand-name medication, so be sure to discuss all prescription drug options with your doctor or health provider.
A good time to enroll in a Medicare plan that includes prescription drug coverage, as in the rest of the U.S., is during your seven-month Medicare Initial Enrollment Period. This period begins three months before you turn 65, includes your birthday month, and ends three months after that month. You must either have or be eligible to enroll in Medicare Part A to enroll in Medicare plans that include prescription drug coverage in Nebraska. If you’re enrolled in Medicare due to a disability, you can enroll in Medicare plans that include prescription drug coverage in Nebraska from three months before until three months after your 25th month of disability.
You can also enroll in Medicare Part D in Nebraska 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 a stand-alone Medicare Part D Prescription Drug Plan through February 14 as well.
You may also join Medicare Part D in Nebraska during the annual Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7. And you can switch Medicare plans that include prescription drug coverage during the same period.
It’s important to understand that if you go without creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period ends, you may have to pay a late-enrollment penalty. The Medicare Part D 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.
Another important thing for you to know is that even if you enroll in a stand-alone Medicare Part D Prescription Drug Plan, 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. Also note that in Nebraska, as in the rest of the United States, Medicare beneficiaries are required to reside in the service area of the stand-alone Medicare Part D Prescription Drug Plan they select.
There are Medicare plans that include prescription drug coverage available in Nebraska and the rest of the U.S. A Medicare Part D Prescription Drug Plan is a stand-alone plan that Medicare beneficiaries may enroll in, alongside Original Medicare, Part A and Part B, to help cover costs for prescription drugs. A Medicare Advantage Prescription Drug plan, on the other hand, combines health and prescription drug coverage into a single plan, offering at least the same coverage as Original Medicare, and sometimes additional benefits, like vision, hearing, and dental, all for a single premium.
When comparing Medicare plans that include prescription drug coverage in Nebraska, it’s always a good idea to take into consideration your individual prescription drug needs, since it’s your prescription drug cost, rather than your premiums or deductibles that usually determines your out-of-pocket expenses.
It may also be smart to review your Medicare plan that includes prescription drug coverage at the end of every year to find out if there were any changes to your coverage. Medicare plans that include prescription drug coverage in Nebraska, like those in the rest of the United States, are may change their premiums, copayments, deductibles, and prescription drug formularies on an annual basis, which means that your present plan may not be the one best suited to your needs in the following year. You will have the opportunity to shop for a new plan every year during the Annual Election Period.
For additional information about Medicare in Nebraska, see the following pages: