As a Medicare beneficiary in Michigan, you can get Medicare Part D prescription drug coverage in two different ways, depending on whether you’re enrolled in Original Medicare or a Medicare Advantage plan. Medicare Advantage, also known as Medicare Part C, is an alternative way to get your Original Medicare Part A and Part B benefits through a Medicare Advantage plan offered by Medicare-approved private insurance companies; many Medicare Advantage plans may also cover benefits beyond Original Medicare, including prescription drug benefits. Another way to receive Medicare Part D prescription drug coverage is by enrolling in a stand-alone Medicare Part D Prescription Drug Plan. Stand-alone Medicare Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare and designed to help Medicare beneficiaries cover prescription drug costs. Costs and benefits for Medicare plans offering prescription drug coverage in Michigan may vary.
How Medicare Part D works in Michigan
Medicare’s prescription drug coverage program, Medicare Part D, works the same in every state. You may want to sign up for a stand-alone Medicare Part D Prescription Drug Plan that serves the area where you live in Michigan if you have made either of the choices listed below regarding how you receive your Medicare benefits:
- You have Original Medicare, Part A and/or Part B
- You have enrolled in a Medicare Advantage plan without prescription drug coverage.
Each of the choices described above provides health coverage and generally restricts prescription drug coverage to medications you may receive during a hospital stay (Part A) or administered by a physician in an outpatient setting (Part B). Stand-alone Medicare Part D Prescription Drug Plans are designed work alongside Original Medicare to provide prescription drug coverage. To be eligible to sign up for a stand-alone Medicare Part D Prescription Drug Plan you must have Medicare Part A and/or Part B and you must live in the plan’s service area.
Each Medicare Part D Prescription Drug Plan in Michigan, as elsewhere in the United States, establishes its own prescription drug benefits and costs, which vary among plans. However most stand-alone Medicare Part D Prescription Drug Plans require you to pay a monthly premium, annual deductible, and copayment or coinsurance.
Also, each Medicare Part D Prescription Drug Plan in Michigan, as elsewhere in the United States, has its own formulary, which is a list of covered prescription drugs. Many Medicare Part D Prescription Drug Plans divide their formularies of covered prescription drugs into tiers (or categories), with each tier having a distinct cost-share, which is the amount you pay out-of-pocket for the medication. The lowest tier includes the least expensive drugs, while the highest tier lists the costliest medications. For example a Medicare Part D Prescription Drug Plan may have a generic and a brand name covered drug on two different tiers. Typically the generic medication is on a tier with a lower out-of-pocket cost than the brand name drug. If your doctor or health-care provider decides that a 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 prescriber can ask your plan for a tiering exception to get lower cost-sharing for a higher tier medication.
In general, Medicare Part D Prescription Drug Plans in Michigan let you choose between brand-name drugs and generic drugs. Generic drugs, as defined by the Food and Drug Administration, are required to have the same active ingredient and strength as brand-name drugs, with the same dosage and administration, and the generic form must be proven to provide the same level of performance. The difference for you is that generic drugs usually cost less than their brand-name counterparts, which may result in significant savings to you. Be sure to discuss all medication options with your doctor.
If you’re enrolled in Medicare due to a disability, you can enroll in a Medicare Part D Prescription Drug Plan in Michigan during the seven-month period that begins three months before your 25th month of disability benefits from the Social Security Administration or Railroad Retirement Board and ends three months after the 25th month in which you receive disability benefits. In most other instances, you can enroll in a Medicare Part D Prescription Drug Plan 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.
Another time you can enroll in a stand-alone Medicare Part D Prescription Drug Plan in Michigan is during the Fall Open Enrollment Period, which runs from October 15 to December 7 each year. If you want to switch from one Medicare Part D Prescription Drug Plan to another, you may do so during the same period.
You may also enroll in a stand-alone Medicare Part D Prescription Drug Plan during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. If you disenroll from a Medicare Advantage plan during this period and go back to Original Medicare, Part A and Part B, you can add a stand-alone Medicare Part D Prescription Drug Plan through January 1 through March 31 . You also may switch Medicare Advantage plans during this period.
Remember that if you remain without prescription drug coverage that is at least as good as Medicare Part D prescription drug coverage (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 Michigan and the rest of 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.
Even if you decide to sign up for a Medicare Part D Prescription Drug Plan, you have to remain enrolled in Medicare and continue to pay any Part A or Part B premium you owe in addition to the premium you pay for your Medicare prescription drug benefits in order to keep your insurance coverage. You may be eligible for Extra Help to help pay some of your out-of-pocket expenses related to Medicare Part D prescription drug benefits.
Evaluating Medicare prescription drug coverage options in Michigan
You may have choices among the Medicare Part D Prescription Drug Plans that are available where you live in Michigan. The two basic types of Medicare plans that offer prescription drug coverage are (1) stand-alone Medicare Part D Prescription Drug Plans and (2) Medicare Advantage Prescription Drug Plans which combine health and prescription drug coverage in a single plan. Both types of Medicare plans providing prescription drug insurance cover prescription drugs frequently used by Medicare beneficiaries. However, there can be differences in prescription drug benefits between plans. Each plan can decide which medications to cover, and most plans place these covered medications into different cost-sharing tiers or categories. This amount can be different for each medication you take if the plan assigns the medications to different tiers.
To help you understand your prescription drug benefits, Medicare plans providing prescription drug coverage publish a current formulary or list of medications they cover. While the formulary may change at any time, you will receive notice from your plan when necessary. The formulary tells you what medications the plan covers and at what cost-sharing tier they are placed.
Before you choose a Medicare plan providing prescription drug coverage be sure to consider your individual prescription needs. Your cost-share for medications may be as significant, if not more significant, a factor in your expenses as your monthly premium. Therefore, check to see that your medications are on a Medicare Part D Prescription Drug Plan’s formulary before you enroll.
It may also be a good idea to review your Medicare Part D plan on an annual basis to find out if there are changes to your coverage. Medicare Part D Prescription Drug Plans in Michigan, like those in the rest of the United States, are allowed to change their premiums, copayments, deductibles, and drug formularies on an annual basis. They will send you two documents, the Annual Notice of Changes and Evidence of Coverage, in early October each year to help you understand these changes. You may even wish to shop for a new plan every year during the Annual Election Period.
To get more details about Medicare in Michigan, access the following pages: