EASY MEDICARE

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan (for those enrolled in Original Medicare) or as a set of benefits included with your Medicare Advantage Plan.

Unless you have creditable drug coverage and have a Special Enrollment Period, you should enroll in Part D when you first get Medicare. If you delay enrollment, you may face gaps in coverage and enrollment penalties.

Each Part D Plan has a list of covered drugs, called its formulary. If your drug is not on the formulary, you may have to request an exception, pay out of pocket, or file an appeal.

A drug category is a group of drugs that treat the same symptoms or have similar effects on the body. All Part D Plans must include at least two drugs from most categories and must cover all drugs available in the following categories:

• HIV/AIDS treatments
• Antidepressants
• Antipsychotic medications
• Anticonvulsive treatments for seizure disorders
• Immunosuppressant drugs
• Anticancer drugs (unless covered by Part B)
• Part D plans must also cover most vaccines, except for vaccines covered by Part B.
• Part D Plans must also cover most vaccines, except for vaccines covered by Part B.
• Some drugs are explicitly excluded from Medicare coverage by law, including drugs used to treat weight loss or gain, and over-the-counter drugs.

Note: Certain drugs, or under specific circumstances, may be covered by Part A or Part B.

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