Last Updated on
October 6, 2016
Medicare Part D is a federal program for providing Medicare beneficiaries prescription drug coverage. Original Medicare, Part A (hospital insurance) and Part B (medical insurance), doesn’t include prescription drug coverage. As a Medicare beneficiary living in Idaho, you may receive Medicare prescription drug benefits from a stand-alone Part D Prescription Drug Plan. Stand-alone Part D Prescription Drug Plans are offered through private insurance companies contracted with Medicare to provide Medicare beneficiaries throughout the United States prescription drug benefits. Part D Prescription Drug Plan costs and availability may vary, depending on the insurance company, the benefit coverage offered, and where you live. You typically pay a monthly premium and may have an annual deductible, copayments and coinsurance when you’re enrolled in one of these plans. Read on to understand Medicare prescription drug coverage , and learn how to look for a stand-alone Part D Prescription Drug Plan that works to meet your prescription drug and budget needs.
Stand-alone Medicare Part D Prescription Drug Plans are designed to work alongside Original Medicare coverage or coverage provided by a Medicare Advantage plan that does not include prescription drug coverage.
In Idaho, as in the rest of the United States, each stand-alone Medicare Part D Prescription Drug Plan has its own list of covered prescription drugs, called a formulary. The medications in the formulary may be grouped into different benefit categories called tiers, each with a different out-of-pocket cost you pay. The lower tiers include the more affordable prescriptions drugs, while the higher tiers include more expensive medications. The formulary may change at any time. You will receive notice from your plan when necessary.
Many Medicare Part D Prescription Drug Plans in Idaho, as in all states, let you choose between brand-name drugs and generic drugs. As Medicare notes, generic drugs are prescription drugs that have the same active-ingredient formula as brand-name drugs. Generic drugs usually cost less than the brand-name equivalents.
To sign up for a Medicare Part D Prescription Drug Plan, you need to meet eligibility requirements and be aware of the enrollment periods.
You can enroll in a stand-alone Part D Prescription Drug Plan available where you reside during your seven-month Medicare Initial Enrollment Period (IEP), This period starts three months before the month you turn 65, includes your birthday month and continues for three months after that month. If you’re enrolled in Medicare due to a disability, your IEP starts three months before your 25th month of disability, includes that month, and continues for three months after.
If you miss your IEP or your Initial Coverage Election Period, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan during the Annual Election Period, which runs from October 15 to December 7 each year, and you can drop or switch Medicare plans during that same period.
If you’re enrolled in a Medicare Advantage plan 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. If you decide to receive your Medicare benefits through Original Medicare, you have until February 14 to add a Medicare Part D Prescription Drug Plan to your coverage if you want Part D prescription benefits.
Don’t forget that you have to continue paying your Medicare Part B premium in order to retain your health coverage. You will probably pay an additional monthly premium for your Medicare prescription drug coverage to the insurance company that provides you this benefit.
Your prescription drug coverage premium may be influenced by other factors. For example you may be eligible to receive Extra Help with the cost of your Medicare prescription drug coverage. On the other hand, if you delay getting Medicare prescription drug coverage, you may have to pay a late-enrollment penalty if you later decide to get this coverage. This late-enrollment penalty may apply if you remain without creditable drug coverage for 63 consecutive days or more after your Initial Enrollment Period ends. Creditable prescription drug coverage means coverage that is comparable to Medicare Part D benefits. This late-enrollment 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 join. 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.
There may be various prescription drug plan options available under Medicare Part D where you live in Idaho. Keep in mind a stand-alone Medicare Part D Prescription Drug Plan is an option that you can enroll in to go alongside your Original Medicare coverage or your Medicare Advantage plan that does not already include prescription drug coverage.
When comparing Medicare Part D Prescription Drug Plans in Idaho, it’s a good idea to take into consideration your medications. Check to see if your medications are on the Part D Prescription Drug Plan’s formulary before you enroll. Understand what you will pay out-of-pocket for your medications by reviewing benefit plan features such as deductibles, copayments and coinsurance. If you are currently enrolled in a Part D Prescription Drug Plan be sure to review carefully your plan’s Annual Notice of Change and Evidence of Coverage in the fall of every year to be aware of any changes to your coverage. Medicare Part D Prescription Drug Plans in Idaho and throughout the United States can change their premiums, copayments, deductibles, and drug formularies every year. Make sure you understand whether your current plan is best suited to your health and budget needs in the coming year or change, if possible, to one that can better serve your ongoing prescription drug coverage needs.
For more information about Medicare in Idaho, view the following articles:
This article is for informational purposes only. Nothing in it should be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.