Lesson 08: Medicare Part D (prescription coverage)
Medicare Part D
Medicare prescription drug coverage is an optional benefit. Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to get Medicare drug coverage when you're first eligible, you'll likely pay a late enrollment penalty if you join later, unless one of these applies:
You have other Creditable prescription drug coverage
You get Extra Help
Generally, you'll pay this penalty for as long as you have Medicare prescription drug coverage.
How to Get the Medicare Drug Benefit:
To get Medicare drug coverage, you must join a plan approved by Medicare that offers Medicare drug coverage. Each plan can vary in cost and drugs covered.
2 ways to get drug coverage
- Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
Facts About the Medicare Drug Benefit:
- Pays for generic and brand name drugs
- Everyone with Medicare is eligible
- This is a voluntary program
- You must join a drug plan to get the benefit (premiums and deductibles apply)
- There is "Extra Help" for those with limited income
- You may have a penalty if you do not join a drug plan when you are first eligible
When Can You Join a Medicare Drug Plan?
- Between October 15--December 7, anyone can join, switch, or drop a Medicare drug plan. The change will take effect on January 1 as long as the plan gets your request by December 7.
- When you`re first eligible for Medicare, you can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
- If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of disability, includes your 25th month of disability, and ends 3 months after your 25th month of disability. You`ll have another chance to join that starts 3 months before the month you turn 65 ends 3 months after the month you turn 65.
- If you get Extra Help, you can join, switch or drop a Medicare drug plan anytime.
Special Enrollment Periods
You generally must stay enrolled for the calendar year. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans at other times:
- If you move out of your plan`s service area
- If you lose other creditable prescription drug coverage
- If you live in an institution (like a nursing home)
How to Join a Medicare Drug Plan
Once you choose a Medicare drug plan, you may be able to join by:
- Enrolling on the plan`s Web site or on http://www.medicare.gov/
- Completing a paper application
- Calling the plan
- Calling 1-800-MEDICARE
When you join a Medicare drug plan, you`ll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.
Click here for information about dropping or switching Part D plans.
How to Choose a Drug Plan
- Gather all personal information including a list of medications with dose and frequency taken
- Get information about what plans cover your drugs at the best price and have the pharmacy you use in their network (Get help at www.medicare.gov)
- Make your decision on cost, coverage and convenience of your own pharmacy choice
Use Medicare`s Plan Finder to find and compare drug plans available in your area.
Help paying for prescriptions and prescription coverage.
If you have limited income and resources, see if you qualify for Extra Help to pay for Medicare prescription drug coverage. You may also be able to get help from your state.