Roughly 44 million caregivers in America provide unpaid care for an adult or child, according to the National Alliance for Caregiving. As a caregiver (whether you’re a son, daughter, friend, or professional caregiver), it’s important to find appropriate prescription drug coverage for your loved one.
If you’re caring for someone with Medicare, coverage is available through Medicare Part D, the program’s prescription drug benefit. If you’re new to the program and would like to know how it works, this information will help you get started.
How to choose a Medicare plan with Part D coverage
Part D prescription drug coverage is available in a few different ways, depending on how a Medicare beneficiary gets his or her Medicare Part A and Part B coverage.
If your care recipient is enrolled in Original Medicare, the federally administered program, then Part D coverage is offered through a stand-alone Medicare Prescription Drug Plan. If you’re caring for someone who gets his Part A and Part B benefits through Medicare Advantage, you may be able to find a Medicare Advantage plan that includes prescription drug benefits.
Both types of plans are available through Medicare-approved private insurance companies, and plans may vary in both cost and the prescription drugs that are covered. Here’s a breakdown of the two types of Medicare plans:
Medicare Advantage Prescription Drug (MAPD) plans: Medicare Advantage (Part C) is another way to get your Original Medicare coverage. Medicare Advantage plans must cover everything under Original Medicare (except for hospice, which is still covered through Part A). Many plans include additional benefits, such as routine vision, dental, hearing, or prescription drugs. Medicare Advantage Prescription Drug plans include Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage). One of the main advantages of a Medicare Advantage Prescription Drug plan is getting all of your benefits under a single plan. Keep in mind that you’ll need to keep paying your Part B premium, in addition to any premium for your Part C coverage.
Stand-Alone Medicare Part D Prescription Drug Plans (PDPs): As mentioned, these are stand-alone plans that only include prescription drug coverage and work with Original Medicare. If you go with this route, you’ll get your Part A and Part B coverage through Original Medicare and your prescription drug coverage through a separate plan. If you’re enrolled in Original Medicare, make sure to get your Part D coverage through a Medicare Prescription Drug Plan, not a Medicare Advantage plan.
What times of the year can my loved one enroll in Medicare Part D?
Your loved one is first eligible for Part D prescription drug coverage when he has Part A and/or Part B and lives in the service area of a plan that includes Part D coverage. This usually takes place at the same time as the Initial Enrollment Period (IEP) for Part B, which is the period that starts three months before a beneficiary first turns 65 and ends 3 months after the month you turn 65 years old..
After the IEP is over, the Annual Election Period (AEP) is often the best time of the year to make changes and add on Part D coverage if your care recipient doesn’t already have it. The AEP begins on October 15 and runs through December 7. During this period, anyone enrolled in Original Medicare can enroll in a Medicare Prescription Drug Plan for the first time, change Medicare plans (such as switching plans or changing from Original Medicare to Medicare Advantage), or disenroll from a stand-alone plan. If you’re enrolled in Medicare Advantage, you can switch plans or disenroll from your Medicare Advantage plan and return back to Original Medicare.
If your loved one has Medicare Advantage and decides to go back to Original Medicare during the Medicare Advantage Open Enrollment Period (January 1 to March 31), he can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan, since Original Medicare doesn’t include Part D benefits. You can also switch from one Medicare Advantage plan to another during this period.
There are also Special Election Periods (SEP) that can take place any time of the year for eligible individuals with special circumstances, such as moving out of a plan’s service area. If you’re caring for someone who has situation that qualifies for a Special Election Period, he’ll be able to make changes to his Part D coverage during the SEP.
Can I help my loved one choose a Medicare plan?
Caregivers (family members and professional caregivers) can use the Medicare Part D plan comparison tool to help a Medicare beneficiary compare and choose a Medicare plan includes prescription drug coverage.
If you need on-the-phone help with a licensed insurance agent, both you and the beneficiary must be on the phone call, and your loved one must give verbal consent before the agent can discuss Medicare coverage options with you.
Keep in mind that if you’re legally acting on behalf of your loved one, you may need to apply to be a legal personal representative to do so – even if that person is your spouse or parent. In some situations, you may need power of attorney before you can make health-care decisions for someone else. In addition, for privacy reasons, Medicare requires beneficiaries to submit an Authorization to Disclose Personal Health Information form before it will disclose Medicare information to anyone other than the enrollee. For more information on becoming a personal representative and other legal documents you may need, contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.
What do I need to start researching plans with Medicare Part D coverage?
An easy-to-use plan comparison tool makes it easy to find plan options that fit your loved one’s prescription drug coverage needs. This free tool, which can be found on this page, also provides estimated costs for Medicare prescription drug coverage, including premiums, copayments, deductibles, and more. These costs vary by zip code, plan, and the quantity and type of medication your loved one takes.
As a caregiver, here are some tips as you help your family member or friend find a Medicare plan with Part D coverage:
- Before starting, collect the names, dosages, and quantities of the medications for the person being enrolled in the Medicare plan (e.g., Lipitor 10mg, quantity 30). If you’re using the plan finder tool, you can enter your loved one’s prescriptions to filter your search and only show plan options that cover those medications
- Keep in mind that, as mentioned, coverage varies by plan, and it’s important to make sure that any plan you’re considering covers the prescription drugs your loved one is taking. To find out, check the plan’s formulary (list of covered drugs), which can usually be found online or by contacting the plan. Remember, the formulary may change at any time, but the Medicare plan is required to notify you if necessary.
- As mentioned, just as coverage may vary, costs may as well. Each plan may have different cost sharing amounts (such as copayments or deductibles) – even to cover the same medications. Typically, Medicare plans with Part D coverage place covered medications into different cost tiers, and your prescription costs will depend on which “tier” your medications fall onto. Brand-name medications tend to be on higher tiers and have higher cost sharing compared with generic medications. Taking the time to research plan options will help your loved one find coverage at a lower cost.
- Always search for plan options by zip code, since not every Medicare plan is available in every location.
- If you need help at any point in your search, just give us a call at the number on this page and a licensed insurance agent can assist you.