Medicare Part D is prescription drug coverage, designed to help Medicare beneficiaries cover prescription drug costs. As a Medicare beneficiary in Alabama, one of the ways you can receive prescription drug coverage is by enrolling in a stand-alone Medicare Part D Prescription Drug Plan; another is to get your Medicare coverage through a Medicare Advantage Prescription Drug plan. Costs for Medicare plan options in Alabama may vary from one plan to another, but many plans require you to pay a monthly premium, annual deductible, and/or copayment or coinsurance.
How stand-alone Medicare Part D Prescription Drug Plans work in Alabama
In Alabama, as in other states, Medicare beneficiaries who want prescription drug coverage may wish to sign up for a stand-alone Medicare Part D Prescription Drug Plan if they currently have Medicare coverage that offers only health coverage, such as Original Medicare, Part A and/or Part B.
Like those in other states, each Medicare plan that includes prescription drug coverage in Alabama has its own list of covered prescription drugs. This list is called a formulary, and it places all covered prescription drugs in different tiers (or categories), each with a different cost. In general, prescription drugs in the lowest tier will cost the least, while those in the higher tier will be priced highest. If your doctor or health provider believes that a drug in a higher tier is medically necessary to treat your health condition instead of a similar drug in a lower tier, you or your doctor can ask your plan for a tiering exception in order to obtain lower cost sharing for a higher tier drug.
A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Under most Medicare plans in Alabama that include prescription drug coverage, you generally have the option to choose between brand-name and generic prescription drugs. As defined by the Food and Drug Administration, generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration, and be proven to perform the same as brand-name drugs. One big difference is that generic drugs typically cost less than brand-name drugs, which means lower out-of-pocket expenses. In certain cases, the 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 your condition.
Be sure to discuss your prescription medications with your doctor or health-care provider.
Enrolling in the Medicare Part D program in Alabama
To enroll in a stand-alone Medicare plan that includes prescription drug coverage, in Alabama, as in other states, you must reside in the service area of your plan. In addition:
- To enroll in a stand-alone Medicare Part D Prescription Drug Plan, you need to either have or be eligible to enroll in Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance).
- To enroll in a Medicare Advantage Prescription Drug plan, you must be enrolled in both Part A and Part B.
In most cases, you can first enroll in either plan type when you’re first eligible for Medicare.
If at any time after your Initial Enrollment Period is over, you remain without creditable drug coverage for 63 days or more, you may be subject to a Medicare Part D late-enrollment penalty if you decide to sign up for this coverage later. The late-enrollment penalty is calculated using 1% of the national base beneficiary premium and the number of full months you were eligible for Medicare prescription drug coverage but didn’t sign up for it. This amount is then added to your stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug plan monthly premium. Remember that the national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
As an Alabama Medicare beneficiary, you can also enroll in a Medicare plan that includes prescription drug coverage during the Annual Election Period, which runs from October 15 to December 7 each year. You’re also able to switch plans during that same period.
Another time you can enroll in a stand-alone Medicare Part D Prescription Drug Plan is during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. If you disenroll from Medicare Advantage during this period and go back to Original Medicare, you can add a stand-alone Medicare Part D Prescription Drug Plan through March 31 as well. You also can switch Medicare Advantage plans during this period.
Types of Medicare plans that include prescription drug coverage in Alabama
A stand-alone Medicare Part D Prescription Drug Plan is different from a Medicare Advantage Prescription Drug plan, in Alabama (and in the rest of the United States).
The stand-alone plan works alongside your Original Medicare (Part A and/or Part B) coverage in order to receive help with prescription drug costs. Or, you can choose to get your Original Medicare benefits (except for hospice care, covered by Part A) through a Medicare Advantage Prescription Drug plan. You need to continue paying your Medicare Part B premium, along with any premium the Medicare Advantage plan may charge.
When choosing a Medicare plan that includes prescription drug coverage, you may want to take into consideration your individual prescription drug needs. This can be important because often it’s your drug cost, rather than just your premiums or deductibles that can determine your main out-of-pocket expenses.
In addition, if you’re already enrolled in a Medicare plan that includes prescription drug coverage, it’s a good idea to review your plan offerings at the end of each year, in order to be aware of any changes to your coverage. In Alabama, as in other states, Medicare plans are allowed to change their premiums, copayments, deductibles, and drug formularies every year. This means that the plan you’re enrolled in today may not be the one best suited to your health needs next year. In addition, your health needs may change over the coming year, so be sure to always keep in mind future medication needs when selecting a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan in Alabama. It is a good idea to shop for a new plan every year during the Annual Election Period.
For more information about Medicare insurance plans in Alabama, see the following pages: