Medicare Part D is a federal program designed to make prescription drug coverage available to Medicare beneficiaries. There are a couple of different ways you can get this coverage, as Original Medicare Part A and Part B do not provide coverage for most prescription medications. Availability of Medicare Part D Prescription Drug Plans in Iowa may vary depending on your place of residence. Get a better understanding of Medicare Part D in Iowa, and receive assistance finding a Medicare Part D Prescription Drug Plan that may work for you.
Types of Medicare plans with prescription drug benefits in Iowa
Medicare Part D is the federal program designed to assist Medicare beneficiaries with prescription drug coverage, whether they live in Iowa 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.
You have a choice in your selection of insurance plans in Iowa that provide Part D prescription drug coverage. Two basic types of plans exist. Depending upon where you live and what other choices you’ve made about your Medicare coverage, one of these two types is likely to be a good fit, providing coverage not available through Original Medicare to help pay some of your medication costs.
One way you can receive Medicare Part D prescription drug coverage is to enroll in a Medicare Advantage Prescription Drug (MAPD) plan where you live in Iowa. A Medicare Advantage Prescription Drug plan combines Medicare 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) provide. Many offer additional health benefits that Original Medicare does not have—such as 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.
Another way you can receive Medicare Part D prescription drug coverage is to enroll in a stand-alone Medicare Part D Prescription Drug Plan. A Medicare Prescription Drug Plan is designed to work alongside your Original Medicare coverage. You can also add Medicare 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.
How Medicare plans with prescription drug coverage work in Iowa
In Iowa, as in every state, each Medicare Part D Prescription Drug Plan and Medicare Advantage Prescription Drug plan has a list of covered prescription drugs, called a formulary. The formulary may change at any time. If enrolled, you will receive notice from your plan when necessary. Typically a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage 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 highest tier includes the most expensive drugs, while the bottom tier lists the most affordable medications. In some cases, your doctor or other healthcare provider may decide that a medication in a higher tier is medically necessary for your treatment instead of a similar prescription drug in a lower tier, you or your doctor can ask your plan for a tiering exception so that you can receive a lower copayment for a higher tier medication.
Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans generally let you to choose between brand-name drugs and generic drugs. According to the Food and Drug Administration (FDA), generic drugs are required to have the same active ingredients, strength, dosage and way to be administered, and they must perform the same as brand-name drugs. Generic drugs usually cost less than the brand-name counterparts, sometimes resulting in substantial savings for Medicare beneficiaries. Be sure to discuss all medication instructions and options with your doctor or prescribing health-care provider.
If you enroll in a Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, you continue to pay any applicable Part A and/or Part B premium(s) to remain enrolled in Medicare to retain your insurance coverage. You may also have a separate monthly premium you pay to the Part D Prescription Drug Plan in exchange for prescription drug benefits.
Eligibility and enrollment details can differ among the various parts of Medicare. The following information outlines eligibility and enrollment processes related to Medicare Part D coverage.
To enroll in a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare, you must have Medicare Part A and/or Part B and live in the Medicare Prescription Drug Plan’s service area. To enroll in a Medicare Advantage Prescription Drug plan, you must have Medicare Part A and Part B and live in the plan’s service area.
- You can enroll in a stand-alone Medicare Part D Prescription Drug Plan during your Medicare Initial Enrollment Period. This seven-month period begins three months before the month you turn 65, includes your birthday month, and ends three months after that month. If you’re enrolled in Medicare due to a disability, your Initial Enrollment Period is generally the seven-month period that begins three months before your 25th month of collecting disability payments, includes that month, and goes for another three months after that month.
- If you choose a Medicare Advantage Prescription Drug, you can sign up during your Initial Coverage Election Period. This period is generally the same as the Initial Enrollment Period described above, unless you delayed enrollment in Medicare Part B.
- If you don’t sign up for Medicare prescription drug coverage when you’re first eligible for Medicare, another opportunity is during the Annual Election Period (also called the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage), which runs from October 15 to December 7 each year. You can make several changes to your Medicare coverage during that time, including (but not limited to) adding, dropping, or switching Medicare Advantage plans and/or stand-alone Medicare Prescription Drug P
Note that if you remain without creditable drug coverage (that is, prescription drug coverage that is at least as good as Medicare Part D) for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty for Medicare Part D if you later decide to add this coverage. 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.
- If you’re enrolled in a Medicare Advantage plan in Iowa (or in any state) and decide to switch back to Original Medicare, Part A and Part B, you may do so during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. You also have until February 14 to add a stand-alone Medicare Part D Prescription Drug Plan to your coverage.
Comparing your Medicare prescription drug coverage options
Whether you are interested in signing-up for a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, it’s to your benefit to shop and compare. While many plans offering Medicare Part D prescription coverage may be in Iowa, not all may be available where you live. You can narrow your search by entering your zip code in the plan finder on this page.
Also, plans offering Medicare Part D prescription coverage 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 plan offering prescription drug coverage, you’ll want to review drug coverage in the fall of every year, to spot any changes to your coverage in the plan’s Annual Notice of Change and Evidence of Coverage documents. Medicare plans in Iowa, like those in the rest of the United States, are allowed to change their prescription drug formularies, premiums, copayments, and deductibles every year. Also, your own medication needs might have changed. This means that the plan you’re enrolled in now may or may not suit your health and budget needs next year.
For additional information on Medicare in Iowa, view the following resources: