Medicare Part D provides prescription coverage through Prescription Drug Plans (PDP) which can vary from state to state. Each PDP has a drug formulary (list) of allowable or covered medications. Covered medications also vary between plans, so it is important to go to the Medicare website and use the Formulary Finder to find a PDP that provides the best access to current medication regimens.
MyMedicare.gov provides direct web access to your Medicare benefits, eligibility, enrollment (including prescription drug plans) and preventive health information – 24 hours a day, seven days a week. Visit the site, sign up, and Medicare will mail you a password to allow you access to your personal Medicare information. MyMedicare.gov also allows you to view your adjudicated claims information, access online forms and publications, and receive important messages from Medicare.
Medicaid is the national health program for individuals and families with low incomes and resources. The Centers for Medicare & Medicaid Services (CMS) is a federal agency that, along with Congress, establishes the main rules that Medicaid must operate within. CMS oversees the state-run Medicaid programs to ensure they meet requirements in all areas of service and quality. Among the groups of people served by Medicaid are eligible low-income parents, children, seniors, and people with disabilities. Since each state runs its own program, the eligibility rules can vary significantly from state to state, although they all must follow the same basic framework set up by CMS. Visit the CMS website to find out if you or your family member is eligible for Medicaid coverage.
Medicaid does not pay benefits to individuals directly; Medicaid sends benefit payments to health care providers. Medicaid helps individuals who have no medical insurance or poor health insurance. In some states Medicaid beneficiaries are required to pay a small fee (co-payment) for medical services.
Dual eligible individuals have both Medicare and Medicaid coverage. These individuals will have prescriptions primarily covered by their Medicare Part D Prescription Drug Plan (PDP) and Medicaid is the secondary payer and may pick up some or all of the cost of those medications not covered by the Medicare PDP.
Medicare Supplementary Medical Insurance (also called Medicare Part B) is available to the elderly, individuals with disabilities and those with end stage renal (kidney) disease. The Social Security Administration is responsible for determining Medicare eligibility and processing premium payments for the Medicare program.
Medicare Part B was created to help cover additional medical-related expenses that are not covered under Medicare Part A (the hospital benefit). Currently, individuals who receive Social Security retirement benefits or who receive Social Security disability benefits for 24 months, or those entitled to Medicare Part A, are automatically enrolled in Part B. They do have the option to decline coverage. Others can enroll in Part B by completing a request form at the Social Security office during certain enrollment periods.
Pharmacy Alternatives works with your private insurance Prescription Drug Plan to make sure that your medications and allowable medical supplies are billed correctly and are paid by your insurance whenever possible. In these times of rising costs for many goods and services, we understand that it is important to get the medications you and your family need at the lowest cost to you. We can offer suggestions to you for cost savings that you can pass on to your physician and will assist you to make optimal use of your healthcare dollars when it comes to medications.
As a private pay customer, you are responsible for the total cost of any medications or related supplies provided to you by Pharmacy Alternatives. This makes it very important for you, your physician, and our pharmacists to work together to ensure that you are getting exactly what you need for the lowest possible cost to you. Our pharmacists can offer viable substitutions for some medications. Generic medicines, for example, are usually less expensive than brand-name medications. We can also suggest a lower-cost, alternative medication to your physician that has the same or similar action to a more expensive choice. Knowing about some of these simple changes that you and your physician can work out together can make a significant difference in your drug costs for the year – up to hundreds of dollars. We are here to assist you.