October 6, 2016
Looking for Information on Medicare Part D?
Medicare Part D is the program that provides Medicare beneficiaries the opportunity to enroll in stand-alone Medicare Part D Prescription Drug Plans or Medicare Advantage Prescription Drug plans, which are offered by Medicare-approved private insurance companies to provide prescription drug coverage.
Medicare Part D – Prescription Drug Coverage
Medicare Part D is prescription drug coverage provided by private insurance companies contracted with Medicare. Medicare Part D coverage helps Medicare beneficiaries pay for prescription drugs that are not covered by Original Medicare, Parts A and B, which are generally limited to medications that are administered during a hospital stay and certain medications administered by a physician in an outpatient setting, such as a clinic.
You may enroll in a stand-alone Medicare Part D Prescription Drug Plan if you have Medicare Part A and/or Part B. To enroll in a Medicare Advantage Prescription Drug plan, which combines health and prescription drug coverage in a single plan, you must have Medicare Part A and Part B. With either type of plan, you must live within the plan’s service area to be eligible to enroll.
In deciding how to receive Medicare Part D coverage, you may choose from one of these two options:
- Enroll in a stand-alone Medicare Part D Prescription Drug Plan to complement your Original Medicare, Part A and/or Part B coverage.
- Enroll in a Medicare Advantage Prescription Drug plan, which combines health and Part D prescription drug coverage in a single plan. Medicare Advantage plans must offer at least the same coverage as Medicare Part A and Part B (except hospice care, which is covered by Part A) and often provide additional benefits, such as routine vision services.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans.
Your annual costs for Medicare Part D prescription drug coverage depend on the plan you choose, the prescription drugs you take and their placement in the plan’s formulary, which is the plan’s list of covered prescription drug. The formulary may change at any time. You will receive notice of the change from your plan when necessary. Stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans may have monthly premiums, annual deductibles, and copayments and coinsurance you pay when you have a prescription filled. Each of these costs may vary among plans.
If you don’t enroll in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan as soon as you become eligible for Medicare Part A and/or Part B, you may face a late enrollment penalty if you enroll later and you have been without creditable prescription drug coverage for at least 63 consecutive days at any time after your Initial Enrollment Period.
However, you will typically avoid this penalty if you have creditable prescription drug coverage –that is, coverage that is, on average, comparable to Medicare Part D coverage—from another source, such as an employer-sponsored group health plan offered by your employer or your spouse’s employer.
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