Ohio Medicare beneficiaries are generally eligible to receive prescription drug benefits through a standalone Medicare prescription drug plan (Medicare Part D). Costs for each Ohio Medicare prescription drug plan vary depending on your particular location and zip code, but be aware that most will require you to a pay a monthly premium, annual deductible, and copayment or coinsurance.
A Medicare Prescription Drug plan is private health insurance, and it’s designed to help Medicare beneficiaries cover prescription drug costs. As an Ohio Medicare beneficiary, you’re eligible to sign up for Medicare Part D drug coverage in addition to your other health coverage, including Original Medicare, Part A and Part B, Medicare Supplement (Medigap), and certain Medicare Advantage (Medicare Part C) health plans.
In Ohio, similarly to other U.S. states, each Medicare 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, 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.
Under most Ohio Medicare prescription drug plans, you generally have to 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 join a prescription drug plan in Ohio, you must either have or be eligible to join Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance), and you must reside in the service area of your PDP plan. You can join an Ohio Medicare prescription drug plan three months before you turn 65 and no later than four months after that date. This is the seven-month Medicare Initial Enrollment Period. If you’re enrolled in Medicare due to a disability, you can join Ohio Medicare Part D from three months before until three months after your 25th month of disability.
Be aware that you will be subject to a lifetime late-enrollment penalty for Medicare Part D in Ohio, if at any time after your Initial Enrollment Period is over you remain without creditable drug coverage for 63 days or more. In Ohio, as in other states, the late-enrollment penalty is calculated using 1% of the national base beneficiary premium ($32.42 in 2014 and $33.13 in 2015) and the number of full months you were eligible for Medicare Part D but didn’t join. 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 Medicare Part D 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 an Ohio Medicare prescription drug plan, you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premiums in order not to lose your health coverage.
As an Ohio Medicare beneficiary, it’s important for you to understand the difference between a Medicare Advantage Prescription Drug plan and Medicare prescription drug plan. A Medicare Advantage Prescription Drug plan combines health and prescription drug coverage into one private insurance plan, offering at least the same coverage as Original Medicare, and sometimes additional benefits such as vision, hearing, and dental, all for a single premium.
A Medicare prescription drug plan, however, is a stand-alone prescription drug plan that beneficiaries generally get in addition to their Original Medicare coverage to receive help with their prescription drug costs. When you’re enrolled in a Medicare prescription drug plan, you have to pay the plan’s premiums in addition to your Original Medicare premiums. When choosing an Ohio Medicare prescription drug plan, remember to always take into consideration your individual prescription drug needs. This is extremely important because it may be your drug cost – and not your premiums or deductibles – that could determine your main out-of-pocket expenses.
If you’re already enrolled in a Medicare prescription drug plan, it’s always 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 the one best suited to your health needs the following year. Also, your health may change over the coming year, so be sure to keep in mind future medication needs when selecting a Medicare prescription drug plan.
Medicare prescription drug plan availability and costs vary by state. In Ohio, your choice of stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage will depend on your zip code, much as in the rest of the country.
Are you ready to learn about the specific Medicare drug plan options available to you? You can go about it in several ways: