If you’re a Medicare beneficiary Georgia, you may be interested in a Medicare prescription drug plan. Original Medicare only offers limited medication coverage in hospitals, so a prescription drug plan is generally your best avenue towards getting your medicine covered.
It’s best to enroll in a Medicare prescription drug plan soon after becoming a Medicare beneficiary. If you wait too long to enroll, you risk incurring late enrollment fees (link). The fees will make any plan you sign up for have higher premiums, which get progressively higher the longer you wait. Having previous drug insurance or Extra Help can help you waive these fees. In addition to this, enrolling in a prescription drug plan early can save you months of out-of-pocket expenses should your need for medication suddenly change. You can only enroll in a Medicare prescription plan at certain times of the year, so the consequences of being caught off guard can be severe.
Medicare Part D vs. Medicare Advantage
Both Medicare Part D and Medicare Advantage can cover your prescription medication. Both are also administered by private insurance companies rather than the federal government. But their structures and availabilities differ. Medicare Part D is an additional insurance you add to Original Medicare. Medicare Advantage, however, offers both what Original Medicare covers and other services (like dental and prescription medication coverage) in a single package. Medicare Part D is available in all 159 Georgia counties. Medicare Advantage, on the other hand, has coverage zones restricted to certain counties and regions. Both offer you plenty of plan options for your prescription drug coverage, though. In Barrow County, for instance, there are 18 potential Medicare Advantage Plans available, in addition to 25 Part D plans.
If you’re in a Medicare Advantage plan, you could find you get better drug coverage at a lower cost through a Part D plan. You should consider carefully before switching plan types: Enrolling in Part D while on Medicare Advantage will automatically disenroll you from Medicare Advantage. This will return you to Original Medicare. The same principle applies if you’re switching to a Medicare Advantage plan from a Medicare Part D plan; you will no longer be enrolled in Parts A and B.
Before you decide to take prescription drug coverage with Part D, you should understand how Medicare drug coverage will work with your current insurance. Enrolling in Medicare Part D may also disqualify you from getting insurance from your union or employer. You should contact your previous insurance and visit this article (link) on how Medicare Part D works with other insurance before making a decision.
When to sign up
There are three main time windows to enroll in Medicare Part D. These are as follows:
- The Initial Enrollment Period (IEP). This is the largest window of time you have to enroll in a Medicare prescription drug plan. It is also the only period you can sign up for Medicare Part D without risking late enrollment fees, regardless of your previous insurance or financial status. The IEP lasts for a total of seven months, beginning three months before the month you’re eligible to become a Medicare beneficiary and ending three months after.
- The Annual Election Period (AEP). This lasts from October 15th to December 7th every year. Should you miss your IEP, this is the most common time to sign up for a Medicare prescription drug plan. Even if you don’t need to enroll in Medicare Part D during this period, it’s a good time to review your prescription drug insurance and decide whether you would benefit from switching to another plan.
- A Special Election Period (SEP). This enrollment period can take place at any time of the year, but you must have specific circumstances to be granted one. One of these circumstances is losing your previous drug coverage because you moved out of your coverage zone. For a full list of the circumstances allowing you a SEP, visit our article here (link).
What are my choices?
Shown below is a table including the 25 Medicare Part D plans available in Georgia. There are seven plans which offer extra drug coverage in the donut hole (link). The cheapest plan with a deductible has an $18.40 monthly premium, and the cheapest plan without a deductible has a $19.80 premium. Despite this, plans without deductibles generally have much more costly premiums. For an explanation on the different Part D benefit types, like “actuarially equivalent standard,” visit our article here (link).
You should also consider more than just this chart before deciding on a plan. For instance, it’s a good idea to know if your plan has a pharmacy network that will reduce costs if you get medication at certain locations. You should also know whether your specific medications are covered in the plan’s drug formulary. If you have further questions, you can speak to one of our insurance agents.
|Organization Name||Plan Name||Plan ID||Benefit Type||Total Premium||Drug Deductible||Gap Coverage
|Aetna Medicare||Aetna Medicare Rx Saver (PDP)||44||Actuarially Equivalent Standard||$22.00||$360.00||No|
|Blue MedicareRx||BCBSGa Blue MedicareRx Standard (PDP)||9||Basic Alternative||$36.90||$360.00||No|
|Blue MedicareRx||BCBSGa Blue MedicareRx Plus (PDP)||10||Enhanced Alternative||$87.40||$0.00||Yes|
|Blue MedicareRx||BCBSGa Blue MedicareRx Premier (PDP)||11||Enhanced Alternative||$135.50||$0.00||Yes|
|EnvisionRx Plus||EnvisionRxPlus Silver (PDP)||10||Actuarially Equivalent Standard||$29.00||$360.00||No|
|Express Scripts Medicare||Express Scripts Medicare – Value (PDP)||112||Actuarially Equivalent Standard||$37.60||$360.00||No|
|Express Scripts Medicare||Express Scripts Medicare – Choice (PDP)||180||Enhanced Alternative||$87.00||$360.00||No|
|First Health Part D||First Health Part D Value Plus (PDP)||133||Enhanced Alternative||$34.90||$0.00||Yes|
|First Health Part D||First Health Part D Premier Plus (PDP)||169||Enhanced Alternative||$81.60||$0.00||Yes|
|Humana Insurance Company||Humana Enhanced (PDP)||9||Enhanced Alternative||$68.00||$0.00||Yes|
|Humana Insurance Company||Humana Preferred Rx Plan (PDP)||135||Actuarially Equivalent Standard||$23.90||$360.00||No|
|Humana Insurance Company||Humana Walmart Rx Plan (PDP)||156||Enhanced Alternative||$18.40||$360.00||No|
|Magellan Rx Medicare||Magellan Rx Medicare Basic (PDP)||11||Actuarially Equivalent Standard||$29.30||$360.00||No|
|SilverScript||SilverScript Choice (PDP)||20||Basic Alternative||$19.80||$0.00||No|
|SilverScript||SilverScript Plus (PDP)||21||Enhanced Alternative||$68.70||$0.00||Yes|
|Stonebridge Life Insurance Company||Transamerica MedicareRx Classic (PDP)||9||Actuarially Equivalent Standard||$118.80||$360.00||No|
|Symphonix Health||Symphonix Value Rx (PDP)||14||Actuarially Equivalent Standard||$24.90||$360.00||No|
|Symphonix Health||Symphonix PrimeSaver Rx (PDP)||55||Enhanced Alternative||$36.60||$200.00||No|
|United American Insurance Company||United American – Enhanced (PDP)||13||Enhanced Alternative||$80.60||$90.00||Yes|
|United American Insurance Company||United American – Select (PDP)||81||Actuarially Equivalent Standard||$59.90||$360.00||No|
|United American Insurance Company||United American – Essential (PDP)||115||Enhanced Alternative||$40.10||$230.00||No|
|UnitedHealthcare||AARP MedicareRx Preferred (PDP)||9||Enhanced Alternative||$63.70||$0.00||No|
|UnitedHealthcare||AARP MedicareRx Saver Plus (PDP)||355||Actuarially Equivalent Standard||$37.40||$360.00||No|
|WellCare||WellCare Classic (PDP)||147||Basic Alternative||$27.00||$360.00||No|
|WellCare||WellCare Extra (PDP)||182||Enhanced Alternative||$62.50||$0.00||No|
Plans are subject to change as contracts are finalized.
Includes contracts/plans as of April 22, 2016. The data does not reflect information for Employer sponsored plans, Part B only plans, or plans not offering a Part D drug benefit.