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Medicare Part D Prescription Drug Plans in Oklahoma

Last Updated on

October 6, 2016

If you’re a Medicare beneficiary living in Oklahoma and need prescription drug coverage, you may want to consider Medicare Part D, which is government-sponsored private insurance designed to help Medicare beneficiaries cover prescription drug costs. Each Medicare Part D Prescription Drug Plan in Oklahoma has different costs, depending on your place of residence and zip code, and most plans generally require you to pay a monthly premium, annual deductible, and copayment or coinsurance. The following information can guide you in finding out what Medicare plans offering prescription drug coverage in Oklahoma may be best suited to your individual health needs.

How does Medicare Part D work in Oklahoma?

Medicare Part D is the federal program designed to assist Medicare beneficiaries with prescription drug coverage, whether they live in Oklahoma or elsewhere in the United States.  However you don’t receive your prescription drug coverage directly from Medicare. Instead, you receive these benefits from private insurance companies contracted with Medicare to offer prescription drug coverage to Medicare beneficiaries where they live. There are two kinds of Medicare plans that provide prescription drug coverage:

  1. Medicare Advantage Prescription Drug plans combine health and prescription drug coverage into a single plan. Medicare Advantage Prescription Drug plans must offer at least the same level of coverage as Original Medicare Part A (hospital insurance) and Part B (medical insurance). Many offer additional health benefits that Original Medicare does not have—such as dental, vision, or hearing—and prescription drug coverage. To sign up for a Medicare Advantage Prescription Drug plan you must have Medicare Part A and Part B, and you must live in the plan’s service area.
  1. Stand-alone Medicare Part D Prescription Drug Plans are designed to work alongside your Original Medicare coverage. If you have Medicare Part A and/or Part B, you can enroll in a Medicare Part D Prescription Drug Plan to receive prescription drug coverage to complement your health benefits. You can also add prescription drug coverage from a Medicare Part D Prescription Drug Plan if you are enrolled in a Medicare Advantage plan that does not provide prescription drug coverage.  To choose this option, you must have Medicare Part A and/or Part B and live in the Part D Prescription Drug Plan’s service area.

Generally, Medicare plans that provide prescription drug coverage share some common benefit features.  These features are described below in the Medicare Part D Prescription Drug Plan example.

Each Medicare Part D Prescription Drug Plan in Oklahoma has a formulary. A formulary is a list of covered prescription drugs.  The formulary may change at any time. If enrolled, you will receive notice from your plan when necessary. Typically a Medicare Part D Prescription Drug Plan groups the medications in its formulary into coverage categories called “tiers”.  Each tier has a designated out-of-pocket cost (e.g., copayment or coinsurance amount) for the medications within the tier.  The top tier includes the most expensive drugs, while the bottom tier lists the less expensive medications. If your doctor determines that a drug in a higher tier is medically necessary for your treatment instead of a similar drug in a lower tier, you or your doctor can ask your plan for a tiering exception  so that you can receive the benefit of a lower copayment for a higher tier medication.

Most Medicare Part D Prescription Drug Plans in Oklahoma permit you to choose between brand-name drugs and generic drugs. The Food and Drug Administration (FDA) defines generic drugs as having the same active ingredients as brand-name drugs, at the same strength, dosage, and with the same method of administration. The FDA also requires that generics are tested to have the same results as brand-name drugs.  Generic drugs often cost less than the brand-name versions, resulting in lower out-of-pocket expenses for Medicare beneficiaries. If a generic drug is not available, your Part D Prescription Drug Plan may allow you to substitute it with a similar generic drug used to treat the same condition instead of paying more for the brand-name drug, so be sure to discuss all prescription drug options with your prescribing doctor or health-care provider.

When can I enroll in a Medicare Part D Prescription Drug Plan?

To receive Medicare prescription drug coverage, you must enroll in a plan offering these benefits in Oklahoma.  Enrollment is not automatic.

If you’re enrolled in Medicare due to a disability, you can enroll in a Medicare Part D Prescription Drug Plan in Oklahoma from three months before until three months after your 25th month of disability. In most other cases, you can enroll during your 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 may sign up for a Medicare Part D Prescription Drug Plan in Oklahoma is during the Annual Election Period for Medicare Advantage and stand-alone 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.

If you disenroll from a Medicare Advantage plan in Oklahoma during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 of each year, and return to Original Medicare, you may be able to add a stand-alone Medicare Part D Prescription Drug Plan through February 14.

Whether you choose a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan, it’s wise to consider enrolling when you first become eligible for Medicare.   If you go without creditable prescription drug coverage (that is prescription drug coverage that is equivalent to Part D coverage) for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty. 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 keep in mind that if you sign up for a Medicare Part D Prescription Drug Plan in Oklahoma, you must remain enrolled in Medicare, and pay any Part A premium (if you’re not entitled to premium-free Medicare Part A coverage) and/or Part B premium in order to keep your Medicare  coverage.

How do I choose a Medicare Part D Prescription Drug Plan in Oklahoma?

You are likely to have choices in your selection of a Medicare plan that provides prescription drug coverage in Oklahoma.

Medicare Part D Prescription Drug Plans in Oklahoma have different costs.  Premiums, deductibles, copayments, and coinsurance are likely to vary.  Also formularies, the lists of covered prescription drugs, may vary. So it’s important to check to see if your medications are on the plan’s formulary and, if so, on which tier.

If you are already enrolled in a Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, it’s a good idea to review your coverage each year. Medicare plans that provide prescription drug coverage are allowed to change their premiums, copayments, deductibles, and formularies each year.  You will receive notice of these changes in the Annual Notice of Changes and Evidence of Coverage the plan mails you in the fall before the new benefits are effective the following January 1st.   You may want to compare plans every year during the Annual Election Period to make sure you are choosing the coverage that best meets your needs.  To assist you in this research, you may enter your zip code in the Plan Finder located on this page.

For additional information about Medicare in Oklahoma, view the following pages: