Last Updated on
October 6, 2016
If you’re enrolled in Original Medicare in Connecticut and need prescription drug coverage, you may consider enrolling in Medicare Part D, which is optional coverage designed to help Medicare beneficiaries cover prescription drug costs. Medicare Part D Prescription Drug Plans in Connecticut (or in any state) may require you to pay a monthly premium, annual deductible, and copayment or coinsurance. Find out what Medicare Part D covers, and get help choosing the Medicare Prescription Drug Plan that may fit your health needs.
To qualify for enrollment in a stand-alone Medicare Part D Prescription Drug Plan in Connecticut, as in all states, you must be enrolled or eligible to enroll in Original Medicare, Part A or Part B. You can also get this coverage through a Medicare Advantage plan that includes prescription drug coverage; for this type of plan, you need to be enrolled in both Medicare Part A and Part B. With either type of Medicare prescription drug coverage, you need to live within the plan’s service area to enroll.
Every Medicare Prescription Drug Plan has its own formulary, which is a list of covered prescription drugs. A formulary divides drugs into different categories called tiers, each with a different cost. The lowest tier includes the most affordable drugs, while the highest tier lists the more expensive medications. If your doctor or health-care provider determines that a drug in a higher tier is necessary for your medical condition instead of a similar drug in a lower tier, you or your prescriber can ask your plan for a tiering exception to get lower cost-sharing for the higher tier drug. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Formularies typically include both brand-name drugs and generic drugs. Generic drugs, according to the Food and Drug Administration, are required to have the same active ingredient(s), strength, dosage form, and route of administration as brand-name drugs, and they must be proven to perform the same as brand-name drugs. A big difference for the consumer is that generic drugs usually cost less than the brand-name versions. In cases where your specific generic prescription drug is not available, you may be allowed to substitute a similar generic drug rather than paying more for a brand-name drug, but be sure to discuss all substitutions and medication details with your doctor or health-care provider.
You can enroll in a stand-alone Medicare Part D, or a Medicare Advantage Prescription Drug plan during your Medicare Initial Enrollment Period. It starts three months before the month you turn 65 and continues for three months after your birth month. If you receive disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB), your Initial Enrollment Period is generally the seven-month period that starts three months before your 25th month of receiving benefits, and continues for three months after that month.
If you sign up for a Medicare Advantage Prescription Drug plan instead of a stand-alone Medicare Part D Prescription Drug Plan, your first opportunity to sign up is during your Initial Coverage Election Period. In most cases, this is the same as the Initial Enrollment Period described above, unless you delay Medicare Part B enrollment.
You can also enroll in Medicare Part D or Medicare Advantage during the Annual Election Period, which runs from October 15 to December 7, and you may switch Medicare Part D Prescription Drug Plans during that same period. If you’re enrolled in a Medicare Advantage plan in Connecticut and decide to switch back to Original Medicare, you can do so during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14, and you have until February 14 to add a Medicare Part D prescription drug plan to your coverage.
Understand that if you remain without creditable drug coverage for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty for Medicare Part D if you decide to enroll later on. In Connecticut and the rest of the United States, this penalty is calculated using 1% of the national base beneficiary premium and the number of full months you were eligible for Medicare Part D but didn’t enroll. This amount is then added to your Medicare Part D Prescription Drug Plan’s monthly premium. The national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
You may have various plan options for your coverage under Medicare Part D in Connecticut, although plan availability varies. You can enroll in a stand-alone Medicare Part D Prescription Drug Plan is to work alongside your Original Medicare, Part A and Part B, coverage. Or, you can enroll in a Medicare Advantage Prescription Drug plan, which combines health and prescription drug coverage into a single plan. A Medicare Advantage plan covers your Original Medicare benefits (except hospice care, which Part A covers), and sometimes carries additional benefits like routine vision, hearing, and dental services, all for a single premium. However, you must still pay your Medicare Part B premium.
When comparing Medicare Part D Prescription Drug Plans in Connecticut, you may want to take into consideration your personal prescription drug needs, since it’s often your prescription drug costs – rather than your premiums and deductibles – that might heavily affect your out-of-pocket expenses.
You might also want to review your Medicare Prescription Drug Plan in the fall of each year, when the plan sends you its Annual Notice of Change and Evidence of Coverage notices. These documents tell you if there are any changes to your coverage. In Connecticut and the rest of the United States, Medicare Prescription Drug Plans may change their premiums, copayments, deductibles, and drug formularies every year. This means that your current plan may not be the one best suited to your health needs in the future.
For more information about other Medicare insurance plans available in Connecticut, read the following resources: