Medicare Part D is a federal program providing Medicare beneficiaries prescription drug coverage.  Original Medicare, Part A (hospital insurance) and Part B (medical insurance), do not include prescription drug.   As a Medicare beneficiary living in Kentucky, you may receive Medicare prescription drug benefits from a Medicare Part D Prescription Drug Plan.  Medicare Part D Prescription Drug Plans are available from private insurance companies contracted with Medicare to provide Medicare beneficiaries Medicare prescription drug benefits. Part D Prescription Drug Plan costs and availability may vary, depending on the insurance company selling the plan, the benefit coverage offered, and where you live. You typically pay a monthly premium and may have an annual deductible, copayments and coinsurance when you’re enrolled in one of these plans.

How Medicare Part D plans work in Kentucky

If you’re a Medicare beneficiary already enrolled or eligible to enroll in Original Medicare, Part A and Part B, you may enroll in a Medicare Part D Prescription Drug Plan. You can also sign up for Medicare Part D if you’re enrolled in a Medicare Supplement (or Medigap) plan or certain types of Medicare Advantage plans.

In Kentucky, each Medicare Part D Prescription Drug plan has a formulary, which is a list of prescription drugs that the plan covers. In Kentucky as is common elsewhere, most Medicare Part D Prescription Drug Plans provide you some choices between brand-name drugs and generic drugs and include both in their formularies.  As Medicare notes, generic drugs are prescription drugs that have the same active-ingredient formula as brand-name drugs. Generic drugs usually cost less than the brand-name medications. The medications in the formulary may be grouped into different benefit categories called tiers, each with a different out-of-pocket cost. The lower tiers include the more affordable prescriptions drugs, while the higher tiers include more expensive medications.  The formulary may change at any time.  If you are enrolled, you will receive notice from your plan when necessary.

Medicare Prescription Drug Plans may also have a network of participating pharmacies and a mail order pharmacy.  Your out-of-pocket costs may be lower when you use the plan’s network pharmacies and/or fill your prescriptions for maintenance medications through the plan’s mail order pharmacy.

You can first enroll in a Medicare Part D prescription drug plan during your Medicare Initial Enrollment Period, which begins three months before you turn 65, includes your birth month, and ends three months after your birth month. You must also have Medicare Part A and/or Medicare Part B in order to sign up for Medicare Part D in Kentucky. If you’re enrolled in Medicare due to a disability, you can enroll in a Medicare Part D prescription drug plan in Kentucky from three months before until three months after your 25th month of disability.

It’s important for you to understand that if you remain without creditable drug coverage for 63 days or more after your Initial Enrollment Period ends, you may be subject to a late-enrollment penalty for Medicare Part D in Kentucky, as you would anywhere else in the United States. This 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.

If you already have Medicare prescription drug coverage, the best time to switch to a new plan is during the Annual Election Period, which runs from October 15 to December 7. If you’re enrolled in a Medicare Advantage Prescription Drug plan in Kentucky and decide to switch back to Original Medicare, Part A and Part B, you can make the change during the  Medicare Advantage Open Enrollment Period, which runs annually from January 1 toMarch 31. You then have until March 31 to add a stand-alone Medicare Part D Prescription Drug Plan to your coverage.

Types of Medicare Part D plans in Kentucky

There are Medicare Prescription Drug Plans available in Kentucky. A Medicare Part D Prescription Drug plan is a stand-alone plan that Medicare beneficiaries get to go alongside Original Medicare, Part A and Part B, in order 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 plus Part D prescription drug coverage. A Medicare Advantage Prescription Drug plan may also include extra benefits like routine vision, hearing, and dental, all for a single premium.

When comparing Medicare Part D Prescription Drug plans in Kentucky, it’s always important to take into consideration your personal prescription drug needs, since it’s your prescription drug cost, rather than your premiums or deductibles, that contribute largely to your out-of-pocket expenses.

It may also be a good idea to review your Medicare Part D plan at the end of each year, in order to determine if there were any changes to your coverage. Medicare Part D plans in Kentucky and the rest of the United States are allowed to change their premiums, copayments, deductibles, and drug formularies every year. You will receive notice of these changes in the Annual Notice of Changes and Evidence of Coverage the plan mails you in the fall before the new benefits are effective the following January 1st.

For additional information about Medicare in Kentucky, access the following resources: