Last Updated on
October 6, 2016
Medicare Part D is a federal program providing Medicare beneficiaries prescription drug coverage. Original Medicare, Part A (hospital insurance) and Part B (medical insurance), does not include prescription drug coverage except in limited situations (for example, it may cover medications when you’re a hospital inpatient, or in an outpatient office setting). As a Medicare beneficiary living in Rhode Island, you may be able to receive Medicare prescription drug benefits from a stand-alone Medicare Part D Prescription Drug Plan, or through a Medicare Advantage Prescription Drug plan. Both types of plans are available through private, Medicare-approved insurance companies.
Each Medicare Prescription Drug Plan has a formulary, which is a list of prescription drugs that the plan covers. In Rhode Island, as in the other states, most Medicare Prescription Drug Plans provide you some choices between brand-name drugs and generic drugs and include both in their formularies. According to the U.S. Food and Drug Administration, generic drugs are prescription drugs that have the same active ingredient as brand-name counterparts. 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 (typically including generic drugs), while the higher tiers include more expensive medications. The formulary may change at any time. You will receive notice of the change from your plan when necessary.
Many stand-alone Medicare Part D Prescription Drug Plans also have their own network of participating pharmacies and a mail order pharmacy. The same is true in many Medicare Advantage Prescription Drug plans. Your out-of-pocket costs are generally 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 stand-alone Medicare Part D Prescription Drug Plan, or a Medicare Advantage plan, during your Medicare Initial Enrollment Period. This period typically begins three months before you turn 65, includes your birth month, and ends three months after your birth month. If you’re enrolled in Medicare due to a disability, you can generally enroll in a Medicare Part D prescription drug plan in Rhode Island from three months before until three months after your 25th month of receiving disability benefits.
You must have Medicare Part A and/or Medicare Part B in order to sign up for a stand-alone Medicare Part D Prescription Drug Plan in Rhode Island. For Medicare Advantage plans, you need to have both Part A and Part B. In either case, you need to live in the plan’s service area.
It’s important to consider that if you remain without creditable drug coverage (that is, coverage that is as good as Medicare Part D prescription 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 Rhode Island, 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 didn’t sign up for a Medicare Prescription Drug Plan during your Initial Enrollment period, or if you already have Medicare prescription drug coverage and want to change plans, 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 Rhode Island and decide to switch back to Original Medicare, Part A and Part B, you can make the change during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. You then have until February 14 to add a Medicare Part D Prescription Drug Plan to your coverage.
As a Medicare beneficiary you have a choice in the type of Medicare plan with prescription drug coverage you select. A Medicare Part D Prescription Drug plan is a stand-alone plan that can work in conjunction with your Medicare Part A and/or Part B to help cover your 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 (with the exception of hospice care, which continues to be covered under Part A) 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. However, you must be enrolled in Medicare Part A and Part B to enroll in a Medicare Advantage Prescription Drug plan. If you have only Medicare Part A or Part B (perhaps because you have coverage from an employer or former employer or union group health plan), or you prefer to have Original Medicare (Part A and Part B), a stand-alone Medicare Part D Prescription Drug Plan is the type of plan you will want to consider.
You will want to consider cost. Plans offering Medicare prescription drug coverage may have different costs. Premiums, deductibles, copayments, and coinsurance are likely to vary among plans. It may be of interest to know that Rhode Island Medicare beneficiaries may qualify for the Part D Extra Help program for assistance in paying their prescription drug costs. To be eligible you must be enrolled in Medicare and must have a limited amount of income and personal assets. To learn more about this program and other programs, such as the Rhode Island Pharmaceutical Assistance to the Elderly (RIPAE) program, that may be available in your state, you may contact the Rhode Island Senior Health Insurance Program (SHIP).
When comparing Medicare plans providing prescription drug coverage in Rhode Island, it may be smart to take into consideration your personal prescription drug needs, since it’s your prescription drug costs, not simply the premium, that contribute largely to your annual out-of-pocket prescription drug expenses. Therefore, you might want to make sure your medications are on a plan’s list of covered prescription drugs (formulary) before you enroll in the plan.
It may also be a good idea to review your Medicare Prescription Drug Plan at the end of each year, in order to determine if there were any changes to your coverage. Plans in Rhode Island 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 Rhode Island, you are invited to access the following resources: