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In New Jersey, as in other states, Medicare beneficiaries with Original Medicare have the option of signing up with a Medicare plan that offers prescription drug (Part D) coverage. Offered by private insurance companies that contract with Medicare, stand-alone Medicare Prescription Drug Plans help pay for prescription drugs. The availability and cost to New Jersey Medicare beneficiaries interested in enrolling in a stand-alone Medicare Part D Prescription Drug Plan may vary according to the plans and their specific prescription drug benefits available where you live. In most cases you’ll have your choice of several stand-alone Medicare Part D Prescription Drug Plans offered by different companies. Most plans will require payment of a monthly premium, annual deductible, and copayment or coinsurance.
As a New Jersey Medicare beneficiary, you are eligible to sign up for a stand-alone Medicare Part D Prescription Drug Plan if you have Medicare Part A and/or Part B and you do not have prescription drug coverage as part of your Medicare benefits; that is, if you have Original Medicare Part A and Part B, or Original Medicare and a Medicare Supplement (Medigap), or a Medicare Advantage (Medicare Part C) plan that doesn’t provide prescription drug coverage, you generally may enroll in a stand-alone Medicare Part D Prescription Drug Plan.
In New Jersey (as elsewhere) each stand-alone Medicare Part D Prescription Drug Plan has its own formulary. A formulary is a list of covered prescription drugs. The formulary may change at any time. You will receive notice from your plan when necessary. The plan formulary’s covered prescription drugs are placed in different tiers (or benefit categories), generally based on cost. Prescription drugs in the lowest tier tend to cost less, while medications in the highest tier are higher priced. Generally, your out-of-pocket expense, the copayment or coinsurance amount you pay for the prescription drug, will be higher or lower depending on where your medication appears in the tiers. In some instances, if your doctor prescribes a more expensive drug in a higher tier to treat your health condition, you may be eligible for a tiering exception, which could result in a lower copayment for your prescription drug.
Most Medicare Part D Prescription Drug Plans allow you to choose between generic and brand-name prescription drugs. Generic drugs, according to the Food and Drug Administration, are safe equivalent versions of brand-name drugs that use similar active ingredients and offer similar results as the brand-name originals. Beneficiaries usually experience lower out-of-pocket expenses when they choose generic drugs.
Sometimes the standard generic version of your brand-name prescription drug is not available. In some cases, 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.
Naturally, if you are interested in obtaining Part D prescription drug coverage, you want to know whether you are eligible to enroll in a Medicare plan that offers prescription drug coverage and when you can do so.
An important consideration is when to enroll in a Medicare plan that offers Part D prescription drug coverage. You could be subject to a lifetime Part D late enrollment penalty if at any time after the close of your Initial Enrollment Period you remain without creditable drug coverage for 63 continuous days or more. (Creditable prescription drug coverage is coverage that is as good as Part D coverage.) The late enrollment penalty is calculated using 1% of the national base beneficiary Medicare Part D premium ($32.74 in 2020) multiplied by the number of full months you were eligible for a prescription drug plan but didn’t enroll. This amount is then added to your Part D monthly premium. Since the national base Medicare Part D premium could increase each year, your late enrollment penalty could increase as well.
Before you choose a Medicare plan offering prescription drug coverage in New Jersey, it may be helpful to understand you have the option of two different types of plans: a stand-alone Medicare Part D Prescription Drug Plan and a Medicare Advantage Prescription Drug plan. While the Part D prescription drug coverage is similar, each plan works a little differently so you will want to consider which type is better suited to your needs.
You may want to consider the following suggestions as you decide whether to add prescription drug coverage to your Medicare coverage and which plan to choose:
For more information about private Medicare insurance for New Jersey beneficiaries, please see: