Your medicines, checked before you choose.
I'm Erick Vallarino, an insurance agent serving all of Texas, and I live and work here in the Valley. Drug plans can be confusing. I'll explain how they work in plain words, check your medicines for you, and my help costs you nothing.
What is a Medicare drug plan?
It's the part of Medicare that helps pay for the medicines you pick up at the pharmacy. You'll also hear it called Part D.
Original Medicare does not cover most of those medicines. You can add drug coverage in one of two ways:
Private insurance companies run these plans, under rules Medicare sets.
Every plan has its own list and its own pharmacies.
Its own list of medicines
Each plan has a list of the medicines it covers. You'll hear it called a formulary. A medicine one plan covers may not be on another plan's list. Some medicines need approval from the plan, called prior authorization, before it will pay for them. Your doctor or other prescriber may need to send the plan information about why you need the medicine.
Its own pharmacies
Each plan works with certain pharmacies. Some of them cost you less than others. If your pharmacy is not one of them, you could pay a lot more.
It can change every year
Plans can change their list and their pharmacies each year. A medicine that is covered this year may not be covered next year.
The same medicine can cost different amounts.
This surprises a lot of people. On the same plan, one pharmacy can charge you less than another for the very same medicine. Mail order can be different again, and it comes right to your door.
So I don't just check the plan. I check where you fill each medicine, too.
Just an example. What you pay depends on your plan, your medicine and where you fill it.
Medicare words
Get familiar with words used in Medicare Advantage and Part D. Costs and coverage rules vary by plan.
- Premium: Monthly payment to keep your coverage. It can be due even when you do not use services or medicines.
- Deductible: Amount you pay before the plan shares certain costs. Some services and medicines are covered before this applies.
- Copay: A fixed amount for a covered service or prescription. Your share can vary by service or medicine.
- Network: Providers or pharmacies with an agreement with a plan. Check which ones participate and the plan's rules.
- Formulary (drug list): The plan's list of covered prescription medicines. Coverage rules and costs can vary by medicine.
- Out of pocket limit: Yearly cap on your share of certain covered costs. Medicare Advantage medical limits and Part D drug limits are separate. Premiums and items the plan does not cover do not count.
Tell me your medicines. I'll do the checking.
Give me your list
Write down your medicines, or just bring the bottles. Tell me which pharmacy you use now.
I check the plans
I check each medicine against the plans I can offer, at your pharmacy and by mail.
I show you, in plain words
What each plan covers, and where you pay less. You decide. If your plan still fits, I'll tell you to keep it.
Check your plan again every fall.
Every year, your plan mails you a letter about what will change. Please don't put it in a drawer. From October 15 to December 7, you can change your Medicare drug plan or your Medicare Advantage plan for next year. We'll sit down and check your medicines again, together.
Extra Help with medicine costs.
Extra Help is a Medicare program for people with limited income and savings. It helps pay the costs of a drug plan. If you have Medicaid, you may already have it.
If not, it's worth asking about, even if you think you won't qualify. I'll help you apply, and my help costs you nothing.
Not sure your medicines are covered? Let's check together.
Call or text me, and have your list of medicines handy. It only takes a few minutes to get started. For Medicare Advantage, I'm contracted with Aetna Medicare, HealthSpring, Humana, Prominence Health Plan, UnitedHealthcare and Wellcare.