Most people are automatically enrolled in Original Medicare, Part A and Part B, when they turn age 65, receive disability benefits for 25 continuous months, or have certain health conditions such as Lou Gehrig’s disease (ALS) or end stage renal disease (kidney failure). Original Medicare has its limitations in coverage, however. It doesn’t provide prescription drug coverage (except under certain situations in which medications are provided during an inpatient hospital stay or administered by a physician on an outpatient basis). Medicare prescription drug coverage (Part D) is available to Medicare beneficiaries in Indiana, as in other states, from stand-alone Medicare Part D Prescription Drug Plans. Medicare Part D Prescription Drug Plans are offered by Medicare-contracted private insurance carriers and are designed to help Medicare beneficiaries pay for their medication expenses. Another option is the Medicare Advantage Prescription Drug plan, also offered by Medicare-approved private insurance companies, which combines health and Medicare Part D prescription drug coverage in a single plan. The availability of Medicare plans offering prescription drug coverage in Indiana may vary, depending on your place of residence. Medicare Part D plans typically require you to pay a monthly premium, annual deductible, and copayment or coinsurance. Read on to learn more about Medicare plans offering Part D prescription drug coverage in Indiana and how to choose a plan that meets your prescription drug and budget needs.
How Medicare plans offering prescription drug coverage work in Indiana
The enrollment requirements are a little different for a stand-alone Medicare Part D Prescription Drug Plan than from a Medicare Advantage Prescription Drug plan. To enroll in a stand-alone Medicare Part D Prescription Drug Plan, you must already be enrolled in or eligible to enroll in Original Medicare, Part A and/or Part B. To receive prescription drug coverage from a Medicare Advantage Prescription Drug plan, on the other hand, you must have both Medicare Part A and Part B. Both types of Medicare plans offering prescription drug coverage require that you live in the plan’s service area.
The benefit features of stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans are similar. Each Medicare plan providing prescription drug coverage has a list of covered prescription drugs, called a formulary. The formulary may change at any time. You will receive notice from your plan when necessary. The prescription drugs on the formulary are grouped into different tiers (or categories). The higher tiers include the more expensive medications, while the lower tiers contain the more affordable prescription drugs. In certain cases, your doctor may prescribe a prescription drug in a higher tier to treat your health condition instead of a similar drug in a lower tier. If so, you or your prescriber may ask the plan for a tiering exception to receive the lower cost-sharing amount.
In general, Medicare plans offering prescription drug coverage in Indiana (as in every state) let you choose between brand-name drugs and generic drugs, when a generic equivalent is available. The Food and Drug Administration describes generic drugs as having the active ingredient at the same strength and dosage, being administered the same way, and performing the same as brand-name drugs. A difference for you is that generic drugs usually cost less than their brand-name counter-parts, resulting in potentially substantial savings. Always discuss all medication substitutions and instructions with your doctor or other prescribing health-care provider.
You can sign up for a stand-alone Medicare Part D Prescription Drug Plan during the seven-month Medicare Initial Enrollment Period, which typically begins three months before the month you turn 65, includes your birthday month, and ends three months after that month. If you qualify for Medicare due to disability, your Initial Enrollment Period is also a seven-month period, starting at the beginning of your 22nd month of collecting disability benefits and going until the end of your 28th month. Your 25th month of collecting disability is the month you qualify for Medicare.
If you’d rather get your prescription drug benefits through a Medicare Advantage Prescription Drug plan, you can sign up during your Initial Coverage Election Period. This period usually coincides with the Initial Enrollment Period described above, unless you delay enrollment in Medicare Part B. In certain cases, you will have a Special Election Period in which to enroll in Medicare Part B. Once you are enrolled in Medicare Part A and Part B, you may enroll in a Medicare Advantage Prescription Drug plan during this Special Election Period.
You can also enroll in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan in Indiana, as in any state, during the Annual Election Period, which runs from October 15 to December 7 each year, and you may switch or drop plans during that same period.
If you’re enrolled in a Medicare Advantage plan in Indiana and decide to switch back to Original Medicare, Part A and Part B, you’re allowed to do so during the annual Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. If you do so, you also have until March 31 to add a stand-alone Medicare Part D Prescription Drug Plan to your coverage or switch to another Medicare Advantage plan.
Timing is important when you are considering enrollment in a plan that offers prescription drug coverage. Realize that if you remain without creditable prescription drug coverage for 63 consecutive days or more after your Initial Enrollment Period ends, and you decide to get this benefit later, you may be subject to a late-enrollment penalty for Medicare Part D in Indiana, as you would anywhere else in the United States. The 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 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.
Types of Medicare plans offering prescription drug coverage in Indiana
As noted earlier, you can choose the option of receiving Part D prescription drug coverage. If you choose to do so, you can also choose how you receive this coverage. You may enroll in a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare, Part A and Part B insurance. Or, you may enroll in a Medicare Advantage Prescription Drug plan, thus combining health and prescription drug coverage into a single plan. A Medicare Advantage Prescription Drug plan provides at least the same health coverage as Original Medicare (except hospice care which continues to be covered under Part A), and sometimes includes extra benefits such as wellness programs, routine vision, hearing or dental coverage, all for a single premium. You still pay your Medicare Part B premium, in addition to the plan’s premium amount, if any, when you enroll in a Medicare plan providing prescription drug coverage.
When comparing Medicare plans offering prescription drug coverage in Indiana, it may be wise to take into consideration your personal prescription drug needs, since it’s often your prescription drug costs – more than your premiums or deductibles – that drive your out-of-pocket expenses.
It’s also generally a good idea to review your plan’s Annual Notice of Change and Evidence of Coverage notices when you receive them by mail each fall to be aware of any changes to your coverage. Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans in Indiana as with the rest of the United States are allowed to change their premiums, copayments, deductibles, and formularies every year. You will probably want to review cost and coverage to make sure you are receiving the best value and the prescription drug coverage you need for the upcoming year.
Access the following articles for additional information about Medicare in Indiana: