October 6, 2016
Medicare Part D is government-contracted private insurance designed to help Medicare beneficiaries get coverage for their prescription drug costs. As a Medicare beneficiary in Tennessee, you may be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan and PlanPrescriber can be your resource for Tennessee Medicare Part D information and plan comparisons.
If you’re a Medicare beneficiary in Tennessee, you may be receiving health coverage through Original Medicare, Part A (hospital insurance) and Part B (medical insurance), or a Medicare Advantage (Medicare Part C) plan without prescription drug coverage. If so, you may also want to enroll in a stand-alone Medicare Part D Prescription Drug Plan to obtain prescription drug benefits. Medicare Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare.
Each stand-alone Medicare Part D Prescription Drug Plan in Tennessee has a formulary, which is a list of covered drugs. Often, a Part D Prescription Drug Plan groups medications within its formulary into different benefit categories, or tiers. Medications that are assigned to a particular tier, share the same benefit coverage and cost. However, the member cost-share (copayment or coinsurance amount) is different for medications assigned to different tiers. Typically, the top tier includes the costlier drugs, while the bottom tier includes the most affordable medications.
In general, stand-alone Medicare Part D Prescription Drug Plans in Tennessee allow you to choose between brand-name drugs and generic drugs in their formularies, often including many generic drugs in the lower tier. Generic drugs have the same active ingredients as their brand-name counterparts, at the same strength, dosage, and with the same method of administration, as defined by the Food and Drug Administration (FDA). In addition, the FDA requires that generics are tested to have the same results as their brand-name counterparts. Generic drugs generally cost less than their brand-name counterparts, which may result in additional cost savings to Medicare beneficiaries.
The formulary and tiers play a significant role in determining the coverage of a prescribed medication. Sometimes, however, upon request, the plan may make exceptions—for example, a plan may make a tiering exception to cover a high- level medication at a lower tier cost-share when a prescribing physician explains that a medication on a higher tier is medically necessary to treat a person’s health condition and that a similar medication on a lower tier cannot be tolerated by the patient. Or a plan may provide a generic drug substitute to a prescribed a brand-name medication to help make the medication cost more affordable for the individual.
Also, a Medicare Prescription Drug Plan’s formulary may change at any time. If enrolled, you will receive notice from your plan when necessary.
To enroll in a stand-alone Medicare Part D Prescription Drug Plan in Tennessee, you must either have Original Medicare, Part A and/or Part B. You are also required to select a Medicare Part D Prescription Drug Plan that serves the area where you live.
If you’re enrolled in Medicare due to a disability, you can enroll in a Medicare Part D Prescription Drug Plan in Tennessee from three months before until three months after your 25th month of receiving disability. In most other cases, you may enroll in a Medicare Part D Prescription Drug Plan 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 enroll in a Medicare Part D Prescription Drug Plan in Tennessee is during the Annual Election Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 each year. You can switch Medicare Part D Prescription Drug Plans during the same period.
You may also be able to sign up for a Medicare Part D Prescription Drug Plan in Tennessee during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. If you disenroll from a Medicare Advantage plan during this period and return to Original Medicare, Part A and Part B, you can add a stand-alone Medicare Part D Prescription Drug Plan through February 14 as well.
Timing of enrollment in a Medicare Part D Prescription Drug Plan is an important consideration. If you go without creditable drug coverage (that is, prescription drug insurance that is at least as good as Medicare Part D ) for 63 consecutive days or more after your Initial Enrollment Period ends, you may be liable for a late-enrollment penalty for as long as you remain enrolled in Medicare Part D. 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 Tennessee, you have to remain enrolled in Medicare and pay any applicable Part A and/or Part B premiums (if you’re not entitled to premium-free Medicare Part A coverage), in order to keep your insurance coverage.
If you are concerned that you can’t afford prescription drug coverage, you may want to look into the Medicare Part D Extra Help program to see if you are eligible to participate. To learn more, please contact the Tennessee State Health Insurance Assistance Program (SHIP).
You may have options regarding the type of Medicare plan offering prescription drug coverage available where you live in Tennessee. A Medicare Part D Prescription Drug Plan is a stand-alone plan that Medicare beneficiaries may enroll in to work alongside Original Medicare, Part A and/or Part B or a Medicare Advantage plan that does not include prescription drug coverage. Another option you may have is to enroll in a Medicare Advantage Prescription Drug plan, which combines health and prescription drug coverage into a single plan and offers at least the same coverage as Original Medicare. As is the case with stand-alone Medicare Part D Prescription Drug Plans, Medicare Advantage Prescription Drug plans are offered by private insurance companies contracted with Medicare. Medicare Advantage Prescription Drug plans in Tennessee may offer additional benefits to health and pharmacy coverage– like routine vision, hearing, and dental—all from a single plan.
When comparing Medicare Part D Prescription Drug Plans in Tennessee, it’s a good idea to take into consideration your individual prescription drug needs. Remember your out-of-pocket costs for medications often play a more significant role than the monthly premium when considering your total anticipated prescription drug expenses for the year. For this reason, you may want to look at plans’ formularies first, making sure that the plan you select has your medications in its formulary of covered prescription drugs and noting in which tiers these medications appear. The more of your medications that appear in a plan’s formulary, and on a lower cost-sharing tier, the greater value the plan’s coverage is to you.
If you are already enrolled in a Medicare plan with prescription drug coverage, you will want to review your plan on an annual basis, in case there are any changes to your coverage. Medicare Part D Prescription Drug Plans in Tennessee, like those in the rest of the United States, are permitted to change their premiums, copayments, deductibles, and drug formularies every year, which means that your present plan may not provide the best fit for your health needs the following year. Each fall your plan will mail you two documents, the Annual Notice of Change and the Evidence of Coverage booklet, which explains plan changes in the coming year. You may even want to evaluate Medicare plans with drug coverage available where you live every year during the Annual Election Period.
For more information about Medicare in North Carolina, view the following resources: