The United States Government mandates, by category, the number of drugs covered by each Medicare Plan. For example: If the mandated number for blood pressure medicines is 100, the insurance company must offer 100 different blood pressure medications. This formula applies for all drug categories. The company compiles a list of drugs offered, identified as a “Formulary.” Each insurance plan has its own Formulary. Formularies can, and do, change from year to year. Insured individuals are responsible for finding a plan with a Formulary that supplies the drugs needed.
Individuals must change, or begin, any Medicare Plan during a prearranged period of time each year. This is known as the Medicare “Enrollment Period.” A participant, whether new to Medicare or changing plans, must sign-up or switch plans during the Enrollment Period. Refer to the Medicare website or call Medicare for this year’s enrollment dates. Miss the enrollment period and a late fee may apply.
Before the enrollment period begins, compile a list of current personal prescriptions. This list is essential for choosing the correct Medicare Plan drug coverage. Each drug must be compared to each plan’s Formulary. The personal prescription list is necessary to easily locate the required prescriptions.
Due to the Formulary system, it is essential to periodically review the personal prescription list. Each insurance company supplies a monthly Explanation of Benefits, or EOB, for each participant. The EOB provides invaluable information. Reviewing this information allows an individual to track the cost of each drug for future reference. If costs are too high, a doctor may be able to prescribe a similar or equivalent drug for less.