October 6, 2016
Ohio Medicare beneficiaries are generally eligible to receive prescription drug benefits through a stand-alone Medicare Prescription Drug Plan (under the Medicare Part D program). Costs for each Ohio Medicare Prescription Drug Plan may vary among plans, but be aware some plans may require you to pay costs such as a monthly premium, annual deductible, and copayment or coinsurance.
Medicare Prescription Drug Plans are available from private health insurance companies that contract with Medicare, and they’re designed to help Medicare beneficiaries cover prescription drug costs.
Why would you want to enroll in Medicare prescription drug coverage if you’re already covered under Original Medicare, Part A and Part B? You don’t have to get prescription drug coverage, but you need to be aware of two things:
In Ohio, similarly to other U.S. states, each Medicare Prescription Drug Plan has its own list of covered prescription drugs. This list is called a formulary, and it places all covered drugs in different categories called tiers, each with a different cost. In general, prescription drugs in the highest tier will be the most expensive, and drugs in the lowest tier will cost the least. If your doctor or health provider believes that a drug in a higher tier is necessary to treat your health condition, and if you deem the prescription drug to be too expensive, you are allowed to ask your plan for a tiering exception in order to obtain a lower copayment for your drug. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Under most Medicare Prescription Drug Plans in Ohio as in all states, you generally have an option to choose between brand-name and generic prescription drugs. According to the Food and Drug Administration generic drugs are safe copies of brand-name drugs that use almost identical active ingredients and offer similar results as the brand-name originals. The big difference is that generic drugs cost much less than brand-name drugs and result in significantly lower out-of-pocket expenses for Ohio Medicare beneficiaries. In certain cases, the exact same generic version of your brand-name prescription drug may not be available, but there may be a similar generic drug that could work just as well for you. Be sure to discuss all such generic drug options with your doctor or health care provider.
To sign up for a Medicare Prescription Drug Plan in Ohio (as in any state), you must either have or be eligible to enroll in Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance), and you must reside in the plan’s service area. You can enroll in a Medicare Prescription Drug Plan during your Medicare Initial Enrollment Period. That is not your only opportunity to sign up for a Medicare Prescription Drug Plan, but be aware that you could be subject to a lifetime late-enrollment penalty for Medicare Part D if you delay enrollment. The Part D late-enrollment penalty may apply if you remain without creditable drug coverage for 63 days or more after your Initial Enrollment Period is over. In Ohio, as in other states, 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 Medicare Part D but didn’t sign up. This amount is then added to your Medicare Part D monthly premium. Remember that the national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase.
You can also enroll in an Ohio Medicare prescription drug plan during the Annual Election Period which runs from October 15 to December 7 each year. You are also allowed to switch plans and make certain other coverage changes during that same period.
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, in Ohio and the rest of the United States. You also have until February 14 to add a Medicare Prescription Drug Plan to your health insurance coverage.
Remember that if you choose to enroll in a stand-alone Medicare Part D Prescription Drug Plan in Ohio (as in any state), you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premium.
As an Ohio Medicare beneficiary, it’s important for you to understand the difference between a Medicare Advantage Prescription Drug plan and a stand-alone Medicare Part D Prescription Drug Plan. Medicare Advantage Prescription Drug plans, available from private, Medicare-approved insurance companies, combine health and prescription drug coverage into one plan. Medicare Advantage plans provide Original Medicare benefits (except hospice care, which is covered under Medicare Part A), and sometimes include additional benefits such as routine vision, hearing, and dental services, all for a single premium. However, as mentioned above, you must continue paying your Medicare Part B premium.
Stand-alone Medicare Part D Prescription Drug Plans are also available from private, Medicare-approved insurance companies, but they don’t include your Medicare Part A and Part B benefits. If you prefer to stay with Original Medicare, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage. When you’re enrolled in a stand-alone Medicare Part D Prescription Drug Plan, you have to pay the plan’s premium (if it charges one) in addition to your Original Medicare premium(s).
If you’re already enrolled in a Medicare Part D Prescription Drug Plan, it may be a good idea to review your plan offerings at the end of the year, to track any important changes. In Ohio, as in other states, Medicare Prescription Drug Plans are allowed to change their premiums, copayments, deductibles, and drug formularies every year, so the plan you’re currently enrolled in may not be suited to your health needs the following year. Also, your health may change over the coming year, so be sure to keep in mind your expected future medication needs when selecting a Medicare Prescription Drug Plan.
Medicare prescription drug plan availability and costs may vary. When choosing a Medicare Part D Prescription Drug Plan, remember to always take into consideration your individual prescription drug needs. To get started comparing plans, just enter your zip code in the form on this page.