Last Updated on
October 6, 2016
If you’re a Medicare beneficiary living in Montana, you may want to consider enrolling in Medicare Part D to get coverage for your prescription drug costs. Medicare Part D is the program where Medicare-approved private insurance companies offer Medicare plans that include prescription drug coverage. Costs for these plans in Montana vary depending on your location and zip code, but may require payment of a monthly premium, annual deductible, and copayments or coinsurance.
As a Medicare beneficiary in Montana, you may be receiving health coverage through Original Medicare, Part A and Part B. If so, you may want to think about enrolling in Medicare Part D to get help paying for your prescription drug expenses.
Each Medicare plan that includes prescription drug coverage in Montana has a formulary, which is a list of covered prescription drugs. The formulary separates drugs into various categories (or tiers), each with a different cost (the formulary may change at any time; the plan will notify you when necessary). The bottom tier lists the least expensive prescription drugs, while the top tier includes higher-priced medications. If your physician determines that a prescription drug in a higher tier is medically necessary for your treatment instead of a similar prescription drug in a lower tier, you or your physician can ask your plan for a tiering exception, which would allow you to get lower cost-sharing for a higher tier prescription drug.
Most Medicare plans that include prescription drug coverage in Montana allow you to choose between brand-name prescription drugs and generic prescription drugs. The Food and Drug Administration describes generic prescription drugs as having the same active ingredients as brand-name prescription drugs, at the same strength, dosage, and with the same method of administration, and generics are tested to have the same results as brand-name prescription drugs. The difference is that generics usually cost less than brand-name versions, so you end up paying less for your medication. If a generic prescription drug is not available, your Medicare plan that includes prescription drug coverage may allow you to substitute it with a similar generic prescription drug instead of paying the higher price for the brand-name medication, so be sure to discuss all prescription drug options with your doctor.
You can enroll in Medicare Part D in Montana during your seven-month Medicare Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. You must either have or be eligible to join Medicare Part A to enroll in Medicare Part D in Montana. If you’re enrolled in Medicare due to a disability, you can enroll in Medicare Part D in Montana from three months before until three months after your 25th month of disability.
Another time you can enroll in Medicare Part D in Montana is during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year. If you dis-enroll from a Medicare Advantage plan during this period and return to Original Medicare, Part A and Part B, you can add a stand-alone Medicare Part D Prescriptions Drug Plan through February 14 as well.
You may also enroll in Medicare Part D in Montana during the Annual Election Period, which runs from October 15 to December 7 each year. And you can switch your Medicare plan that includes prescriptions drug coverage during the same period. In Montana and the rest of the United States, Medicare beneficiaries are required to reside in the service area of the Medicare plan that includes prescription drug coverage that they choose.
Always remember that if you go without creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty. The Medicare Part D 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.
Also remember that even if you enroll in a Medicare plan that includes prescription drug coverage, you have to remain enrolled in Medicare Part A and pay any Part A premiums (if you’re not entitled to premium-free Medicare Part A coverage) to retain your health insurance coverage.
Medicare plans that include prescription drug coverage are available in Montana. A stand-alone Medicare Part D Prescriptions Drug Plan is a plan that Medicare beneficiaries may get in addition to Original Medicare, Part A and Part B, which may help cover costs for prescription drugs. A Medicare Advantage Prescription Drug plan, on the other hand, combines health and prescription drug coverage into a single plan, offering at least the same coverage as Original Medicare, and sometimes additional benefits, like vision, and dental, all for a single premium.
When deciding between Medicare plans that include prescription drug coverage in Montana, it’s smart to consider your personal prescription drug requirements, since it’s the costs of your prescription drugs –more so than your premiums or deductibles–that usually determine your out-of-pocket expenses.
You should also review your Medicare plan that includes prescription drug coverage at the end of the year to see if there are any possible changes to your prescription drug coverage. Medicare plans that include prescription drug coverage in Montana and the rest of the United States are able to change their premiums, copayments, deductibles, and prescription drug formularies on an annual basis, which means that your current plan may not suit your prescription drug needs in the coming year. You may even want to shop for a new plan every year during the Annual Election Period.
View the following pages for more information about Medicare in Montana: