Last Updated on
October 6, 2016
In New Hampshire, as in the rest of the United States, Medicare beneficiaries may have the option of enrolling in a Medicare plan that includes prescription drug coverage for their prescription drug expenses. Every Medicare plan that includes prescription drug coverage in New Hampshire has a different cost, depending on each individual beneficiary’s location and zip code, but most require payment of a monthly premium, annual deductible, and copayments or coinsurance.
As a Medicare beneficiary in New Hampshire, you may be receiving health coverage through Original Medicare, Part A and Part B. To add prescription drug coverage to your health benefits, you may want to consider enrolling in Medicare Part D. Here’s an overview of what Medicare Part D in New Hampshire may offer.
Each Medicare plan that includes prescription drug coverage in New Hampshire has its own formulary, which is a list of covered prescription drugs. The formulary divides prescription drugs into different tiers (or categories), each with a different cost. (A formulary may change at any time. You will be notified when necessary.) The bottom tier, for example, lists the most affordable prescription drugs, while the highest tier includes the more expensive medications. If your doctor or health-care provider decides that a prescription drug in a higher tier is medically necessary to treat your health condition instead of a similar drug in a lower tier, you or your doctor can ask your plan for a tiering exception to get a lower copayment for your prescription drug.
In New Hampshire, as in the rest of the United States, Medicare plans that include prescription drug coverage generally allow you to choose between generic prescription drugs and brand-name prescription drugs. Generic prescription drugs, as defined by the Food and Drug Administration (FDA), have the same active ingredients as brand-name prescription drugs, at the same strength, dosage, and with the same method of administration. The FDA requires that generics are tested to have the same results as brand-name prescription drugs. However, generic prescription drugs usually cost less than their brand-name counterparts. If a generic prescription drug is not available, your plan may allow you to substitute it with a similar generic prescription drug instead of paying the higher price for the brand-name prescription drug, so be sure to discuss all prescription drug options with your doctor or health-care provider.
If you’re enrolled in Medicare due to a disability, you may enroll in Medicare Part D in New Hampshire from three months before until three months after your 25th month of disability. In most other cases, the best time to enroll in Medicare Part D in New Hampshire is during your seven-month Medicare Initial Enrollment Period. This period 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 enroll in Medicare Part A to enroll in Medicare Part D in New Hampshire, as in the rest of the U.S.
You may also enroll in Medicare Part D in New Hampshire during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. If you disenroll from Medicare Advantage during this period and return to Original Medicare, Part A and Part B, you may add a stand-alone Medicare Part D Prescription Drug Plan through February 14 as well.
You also can enroll in Medicare Part D in New Hampshire during the annual Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7. And you can switch Medicare plans that include prescription drug coverage during the same period.
It’s important to remember that if you go without creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period ends, you may have to pay a late-enrollment penalty. The penalty for Medicare Part D 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.
You also need to keep in mind 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 keep your health insurance coverage. You’ll also need to continue paying your Medicare Part B premium, along with any premium the Medicare Advantage plan requires, as well as any copayments, coinsurance, and deductibles. Also remember that in New Hampshire, as in the rest of the United States, you are required to live in the local area of your selected Medicare plan that include prescription drug coverage.
There are various Medicare plans that include prescription drug coverage available in New Hampshire. A Medicare Part D Prescription Drug Plan is a stand-alone plan that Medicare beneficiaries may enroll in alongside Original Medicare, Part A and Part B, to 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. Medicare Advantage Prescription Drug plans sometimes have additional benefits, like vision, hearing, and dental, all for a single premium. Medicare Advantage is alternative way to receive your Original Medicare benefits, except for hospice care, which Medicare Part A still provides. Please note that with a Medicare Advantage Prescription Drug plan, you’ll still need to continue paying your Medicare Part B premium, along with any premium the plan requires, as well as any copayments, coinsurance, and deductibles.
When comparing Medicare plans that include prescription drug coverage in New Hampshire, it may be important to take into consideration your individual prescription drug needs. Remember it’s your prescription drug cost, rather than your premiums or deductibles, which generally determines your main out-of-pocket expenses.
It may also be a good idea to review your Medicare plan that includes prescription drug coverage at the end of each year, to find out if there were any changes to your coverage. Medicare plans that include prescription drug coverage in New Hampshire and the rest of the United States are allowed to change their premiums, copayments, deductibles, and prescription drug formularies on an annual basis, meaning that your present plan may not suit your prescription drug needs the following year. (Note that your plan’s formulary, or list of covered prescription drugs may change at any time; you will be notified when necessary.) You may even want to shop for a new Medicare plan option every year during the Annual Election Period.
Medicare plans that include prescription drug coverage have availability and costs that vary by state.
Access the following pages for additional information about Medicare in New Hampshire: