What Types of Medicare Part D Coverage Does Anthem Offer?
This article was updated on: 10/21/2018
Anthem is a private insurance company approved by Medicare to offer prescription drug coverage under the Medicare program. Here’s an overview of how you can get Anthem Medicare plans with coverage for prescription drugs.
What is Anthem Medicare Part D coverage?
Prescription drug coverage under the Medicare program went into effect in 2006 as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The minimum standards for Medicare Part D prescription drug coverage are set by the Medicare program, and private companies approved by CMS to offer them, including Anthem, must meet these standard benefits.
You can get your Medicare Part D coverage through Anthem in one of two ways:
- Stand-alone Anthem Medicare Part D Prescription Drug Plans. These plans are designed to work alongside your Original Medicare (Part A and Part B). They cannot be combined with other Anthem Medicare health plans with prescription drug coverage, such as an Anthem Medicare Advantage plan that covers medications. In fact, if you enroll in a stand-alone Anthem Medicare Part D Prescription Drug Plan while you are enrolled in a Medicare Advantage plan with prescription drug coverage, you will be removed from your Medicare Advantage plan and enrolled in Original Medicare automatically. The exception is if you’re enrolled in a Medicare Advantage plan that doesn’t include prescription drug benefits, such as a Medical Savings Account plan, you may be allowed to enroll in a stand-alone Prescription Drug Plan.
- Anthem Medicare Advantage plans with prescription drug coverage. Many Anthem Medicare Advantage plans (Part C) include coverage for prescription drugs, as well as other benefits, such as routine vision and dental care and wellness programs. Also known as Medicare Advantage Prescription Drug plans, these plans offer your Part A, Part B, and Part D coverage in one convenient plan. Keep in mind, you must continue to pay your Part B premium if you enroll in an Anthem Medicare Advantage plan, and you may have an additional monthly premium for your Medicare Advantage coverage, depending on the plan you select. If you enroll in a Medicare Advantage Prescription Drug plan, your monthly plan premium will reflect both the cost of your Part C and Part D coverage.
Not all Anthem Medicare Advantage plans and Anthem Medicare Part D Prescription Drug Plans are available in all locations, and plan benefits and premiums may vary from place to place.
How does Anthem Medicare Part D coverage work?
Anthem Medicare plans that cover prescription drugs use a formulary, which is a list of covered medications and costs. Formularies must include a broad range of both generic and brand-name medications used to treat most health conditions and diseases in certain required drug classes. Plans may make changes to their formularies at any time, but they must notify you in writing before changes take effect.
Some Anthem Medicare plans with prescription drug coverage may use a formulary with built-in cost-control measures, such as:
- Tiered formulary. Plans typically place covered medications into cost tiers, generally with higher cost sharing for prescription drugs in higher tiers and lower costs for medications in lower tiers. Some plans may offer lower copayments or coinsurance for generic medications, while more expensive brand-name prescription drugs may have higher copayments or coinsurance.
- Prior authorization. Your plan may require you to get approval from your prescriber before covering certain classes of prescription drugs or certain types of medications.
- Quantity limits. In some cases, there may be a limit to the number of pills or doses you can get at one time or the number of times you can refill a prescription over a certain time period.
It’s important to get your Anthem Medicare Part D coverage as soon as you are eligible; if you delay, you may have to pay a late-enrollment penalty with your monthly premiums for as long as you have coverage if you don’t sign up for Part D and go without other creditable prescription drug coverage (insurance that is as good as the Medicare Part D benefit) for 63 days or more.
As you can tell, you may have several options available to you for your Medicare Part D coverage. What works best for you may come down to your specific prescription drug needs, budget, and preferences. To start browsing Medicare plan options in your location right now, use the Find Plans button on this page.
Anthem Blue Cross and Blue Shield serves Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.