Medicare Part D includes prescription drug coverage and may also pay for medication that falls under parts A and B. The coverage is typically provided by insurers other than Medicare. Coverage and the rates of reimbursement vary according to the plans and Payers chosen. The federal government pays for 75% of the medication costs while individuals pay for co-pays, deductibles and premiums.
Some Fast Facts with Medicare Part D
- It is for those who are eligible for Medicare and has a prescription medication benefits plan
- The patient has to be either covered under Medicare Part A or Part B to be eligible for the same
- Coverage is optional and is sold by the private companies
- To enroll for Medicare Part D, it has to be done between October 15th and December 7th. Otherwise, late enrollment penalties may apply
- The medications are based upon the formularies of the individual plan i.e. the list of covered drugs
All Part D plans must also be covering at least two, and often many more, medications from the prescribed categories and classes which include:
- HIV medications
- Antidepressants
- Cancer treatment medications
- Immuno-suppressants
- Anticonvulsants
- Antipsychotics
Also majority of the vaccines are covered under the same with no co-pay. It is important to note that a Medicare Part D plan can change the medications on their list of coverage anytime for multiple reasons like:
- A generic of the same brand name becomes available
- The price of brand name medications may change if the generic becomes available
- A new medication is available or there is emerging data about the medication or treatment
Prescription Drugs Not Covered by Medicare Part D
Over the counter medications are generally not covered by Part D plans and that include:
- Supplements
- Vitamins
- Weight loss and cosmetic medicines
Sun Knowledge Sets the Benchmark with Medicare Part D Prescription Services
Our team has the perfect understanding to help you adjudicate claims under Medicare Part D and will help you to evaluate a medical claim properly. We will be reviewing the claim for relevancy and will be ensuring there are no mistakes in the patient’s personal details. We then check that all accurate codes are in order with HCPCS and CPT requirements. Also, we will be checking if the procedures are necessary and valid.
After the evaluation you are left with three options:
- Pay the claim in full
- Reduce the paid out amount
- Claim denial
So what is holding you back? Speak to a Sun Knowledge Inc’s Medicare Part D expert and come to know how we help in accelerating your ‘go to’ marketing and trace referral patterns a lot better. Talk to us anytime!