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Medicare Part D Coverage in Ohio

Medication can get expensive, and original Medicare doesn’t cover those costs. If you have Medicare Parts A and B, you can purchase prescription drug coverage, Medicare Part D.

You cannot buy Medicare Part D coverage in Ohio directly from the government. Instead, you buy it from a private insurance company. It’s a separate plan with separate deductibles, co-pays, and co-insurance. You can buy it from any insurance company that offers a plan for your service area.

Enrolling in Medicare Part D Coverage in Ohio

Medicare Part D coverage is optional. You don’t have to have it, but it’s beneficial to have it alongside your Original Medicare. You have a seven-month window to decide as you are first eligible for Medicare Parts A, B, and D three months before you turn 65 years old. You also have three months after your birthday month to enroll. If you wait until after the seven-month window, you may pay a penalty for Medicare Part D.

Medicare charges a 1 percent penalty for every month that you don’t have prescription drug coverage. It adds this penalty onto your monthly premium. For example, if you don’t have prescription coverage for 36 months, you pay a 36 percent penalty for the rest of your life. That’s 36 percent of the national basic premium for drug coverage.

The only exception to the penalty rule is if you have other credible coverage. This could be:

  • Insurance Coverage From an Employer or Union
  • Medicare Part C (Medicare Advantage)

You must have proof of the credible coverage to have the penalty waived.

Open Enrollment for Medicare Part D Coverage in Ohio

If you miss your chance to buy Medicare Part D during your seven-month window, you can do so again during the Open Enrollment Period. This occurs each year from October 15 to December 7.

During this time, you can join a Medicare Part D plan for the first time. You can also use this time to switch plans, which is helpful if you need to change your medication and coverage. It’s also a good time to compare insurance rates, and perhaps save a few dollars each month by switching.

Note that if you join for the first time during open enrollment, this is when the penalty becomes effective.

Paying for Existing Medications

If you already take medications, pay close attention to each plan’s formulary list. Check with different insurance companies to see what they offer. Medicare requires insurance companies to offer at least two medications in each category. If you already take a specific medication and don’t want to change, you’ll need to find a company that covers it.

Generic Prescription Drugs

If you typically take generic prescription drugs, focus on the plans that have tiered benefits. These plans usually offer little to no co-pay for generic drugs. They then increase your co-pay as you get into the name-brand medications.

If you’re unsure which plan to choose because you currently don’t require any prescription medication, find the plan that offers the price and coverage. This way, you can have peace of mind should you end up on medication in the future.

Paying for Medicare Part D Coverage in Ohio

The Medicare Part D plans in Ohio typically have the following expenses:

  • Premiums — You pay this fee monthly to have the insurance. The premium amount depends on the plan and can vary by insurance company.
  • Annual Deductible — You pay this amount out of pocket before the insurance starts covering the cost of the medication. In 2019, the maximum annual deductible is $415.
  • Co-Payment — The insurance company creates a set amount that you pay for each drug classification. Generic drugs have their own co-pay, as do name-brand drugs.
  • Co-Insurance — You may also have co-insurance, which is a percentage of the cost of the medication. For example, if your co-insurance is 20 percent, you pay 20 percent of the drug. The insurance company covers the rest.

Note: Medicare offers Catastrophic Coverage. This helps limit the amount you pay out of pocket for prescriptions. In 2019, the maximum out of pocket cost is $5,100. After you pay $5,100, your co-insurance and co-payments decrease.

Medicare Part D coverage in Ohio is a great way to limit your out-of-pocket costs for prescriptions. Even if you don’t take prescriptions now, protect yourself for the future. Once you have a plan, you avoid the 1 percent monthly penalty. If necessary, you can then change plans during the Open Enrollment Period.

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