Last Updated on
October 6, 2016
Did you know that Original Medicare, Part A and Part B, doesn’t cover prescription drugs in most cases? The Medicare Part D program lets government-contracted, optional private insurance companies offer benefits designed to help Medicare beneficiaries cover prescription drug costs. If you’re living in Delaware and need this coverage, you may consider enrolling in a Medicare Part D Prescription Drug Plan. Availability and costs for each Medicare Part D Prescription Drug Plan may vary among plans.
Under Medicare Part D in Delaware, as in all states, each Medicare Part D 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 highest tier lists the most expensive medications, while the lowest tier includes the more affordable drugs. If your doctor or health 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 may ask your plan for a tiering exception to reduce your cost for the higher-tier drug. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Medicare Part D Prescription Drug Plans in Delaware and the rest of the United States generally allow you to choose between brand-name drugs and generic drugs.Medicare.gov describes generic drugs as copies of brand-name drugs, with similar active ingredients. Brand-name drugs generally cost substantially more than their generic equivalents. If the generic prescription drug your doctor prescribed isn’t available, you may be allowed to use a similar generic drug rather than paying more for a brand-name drug, but be sure to discuss all drug instructions and substitutions with your doctor or health-care provider.
Be aware that in order to enroll in a stand-alone Medicare Part D Prescription Drug Plan in Delaware, as in any state, you must already be enrolled or eligible to enroll in Original Medicare, Part A or Part B. also If you would rather get Medicare prescription drug coverage through a Medicare Advantage Prescription Drug plan; you need to be enrolled in both Medicare Part A and Part B to enroll in that type of plan. Also note that you must reside in the service area of either type of plan.
You can sign up for a stand-alone Medicare Part D Prescription Drug Plan during your Initial Enrollment Period.
Medicare Advantage Prescription Drug plans have an enrollment period called the Initial Coverage Election Period. It’s usually the same time period as the Initial Enrollment Period described above, unless you delay enrollment in Medicare Part B.
You can also enroll in a Medicare plan that includes prescription drug coverage (either of the types mentioned above) during the Annual Election Period, which runs from October 15 to December 7, and you may switch plans during this period. However, if you don’t enroll in prescription drug coverage when you’re first eligible, you might have to pay a late-enrollment penalty when you do sign up later.
If you’re enrolled in a Medicare Advantage plan in Delaware (or another state) 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.
It’s important for you to know that if you don’t have creditable drug coverage for 63 consecutive days or more after your Initial Enrollment Period ends, you may be subject to a lifetime late-enrollment penalty for Medicare Part D, if you ever do decide to add this coverage. Medicare considers coverage “creditable” if it pays, on average, at least as well as standard Medicare prescription drug coverage pays. In Delaware 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 monthly premium. The national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
In some situations, you can sign up for a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan during a Special Election Period. There are several such situations; one example is moving out of your plan’s service area.
Always remember that you are required to remain enrolled in Original Medicare and continue paying your Medicare Part B premium in order not to lose your health coverage, regardless of whether your enroll in a Medicare plan that includes prescription drug coverage or not.
As a Medicare beneficiary in Delaware, you may have access to various types of Medicare Prescription Drug Plans. If you want to keep your Original Medicare coverage, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan. If you want to get your health and prescription drug benefits through a single plan, you can sign up for a Medicare Advantage Prescription Drug plan. Medicare Advantage plans provide your Original Medicare, Part A and Part B, benefits, and sometimes include additional benefits like routine vision, hearing, and dental services.
When comparing Medicare Part D Prescription Drug Plans in Delaware, be sure to take into consideration your personal medication needs, since your prescription costs might affect your out-of-pocket expenses more than your plan premiums or deductibles. You might want to make sure that the plans you’re considering cover your prescription medications. If you enter your zip code where indicated on this page, you can compare plans available in your vicinity and find out whether they cover your prescriptions.
It may also be a good idea to review your Medicare Part D Prescription Drug Plan at the end of each year to see if there are any changes to your coverage (plans must send you an Annual Notice of Change and an Evidence of Coverage notice every fall). Medicare Part D Prescription Drug Plans may change their premiums, copayments, deductibles, and drug formularies every year. This means that your current plan may not suit your health needs in the coming year.
Check out the following resources for additional information about Medicare insurance in Delaware: