By Lyndsy Gamet, Stakeholder and Network Partners Manager, MiCAFE
Medicare Part D is an optional federal government program that allows Medicare beneficiaries to access prescription drug insurance. The program is administered through private insurance companies. Similar to many insurance plans, there is typically a monthly premium, as well as co-pays for prescriptions.
Part D plans cover many prescriptions. Each plan has a formulary, which is a list of drugs that are covered. Guidelines from the federal government dictate some of the items and their pricing on the formulary for each plan. Plans typically have tiers, which a prescription may fall under. A Tier 1 prescription may only be a few dollars, and Tier 4 and 5 may be a few hundred dollars. There are prescriptions that are not covered that could be very costly. The prescriptions available in each tier differ from plan to plan. As such, a person who is on one or more medications will need to take special notice to see which plans include their prescriptions, and what amount they should expect to pay for them.
There is a program available called Medicare Part D Low Income Subsidy (LIS), or Extra Help, that helps individuals with limited income and assets. This program will help to pay premiums, deductibles, and costs with no more than $8.50 due for any prescription under their plan’s formulary. Additionally, LIS beneficiaries can participate in a special enrollment period where they can change their plan one time every three months. This allows individuals to switch their plan if they find that their necessary medication is not covered.
The application for LIS is available on MiSOAP.org under the “Apply for Benefits” tab. MiCAFE Network staff at Elder Law of Michigan are always happy to help with applications. We are available Monday through Friday, 9am – 3pm at 877-664-2233.