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If you’re a Medicare beneficiary living in Illinois who needs prescription drug coverage, you have two options: (1) you can enroll in a stand-alone Medicare Part D Prescription Drug Plan, or (2) you can sign up for a Medicare Advantage Prescription Drug plan.
Costs for each stand-alone Medicare Part D Prescription Drug Plan or Medicare Advantage plan vary depending on your location and prescription drug benefit, but most plans will require Illinois beneficiaries to a pay a monthly premium, annual deductible, and copayment or coinsurance.
Stand-alone Medicare Part D Prescription Drug Plans are offered by Medicare-approved private health insurance companies and are designed to help Medicare beneficiaries cover prescription drug costs. In Illinois, as in other states, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan in addition to your Original Medicare (Part A and Part B) coverage.
You can also obtain Medicare prescription drug coverage by enrolling in a Medicare Advantage Prescription Drug plan, which combines health benefits and prescription drug benefits into a single plan.
Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans share some common prescription drug benefit features. Each has its own list of covered prescription drugs. This list is called a formulary, and the covered prescription drugs are placed in different categories, called tiers. Prescription drugs in the lowest tier will generally cost the least, while medications in the higher tier will be priced higher. If your doctor or prescribing health provider believes that a drug in a higher tier is medically necessary to treat your health condition, and you can’t afford that prescription drug, you may be able to ask your plan for a tiering exception to let you pay a lower copayment. The formulary may change at any time. You will receive notice from your plan when necessary.
In Illinois, most Medicare plans providing prescription drug coverage will let you choose between brand-name and generic drugs when filling prescriptions. A generic drug is a substitute for a brand-name drug that uses similar active ingredients and offers similar results. Generic drugs typically cost less than brand-name medications. In certain cases, the generic version of your brand-name prescription drug may not be available, but there may be a similar generic drug that could work just as well for your particular condition. Be sure to discuss all such generic drug options with your doctor or other prescribing health care provider.
In Illinois as in other states, you may be faced with a lifetime Medicare Part D late-enrollment penalty if you don’t enroll in a Medicare plan offering Part D prescription drug coverage when you’re first eligible (during your Initial Enrollment Period), and you remain without creditable drug coverage for 63 consecutive days or more. Creditable drug coverage is prescription drug coverage that is at least as good as Medicare Part D.
The late enrollment penalty is 1% of the national base beneficiary premium ($32.74 in 2020) times the number of months you were eligible for a Medicare plan providing prescription drug coverage but didn’t enroll. This amount is then added to your Part D monthly premium. The national base beneficiary premium may increase each year, which means your late enrollment penalty may also increase.
It’s important to note that if you sign up for an Illinois stand-alone Medicare Part D Prescription Drug Plan, you have to stay enrolled in Part A and/or Part B and continue paying your Medicare Part A and/or Part B premiums, as applicable, to keep your health coverage.
It’s important for you to understand the difference between a stand-alone Medicare Part D Prescription Drug Plan and a Medicare Advantage Prescription Drug plan:
Some things you may want to think about when choosing a Medicare plan that provides prescription drug coverage:
Learn more about how Medicare plans work in Illinois, including: