In addition to hospital and medical insurance, prescription drug coverage is also available through the Medicare program. Whether you’re planning to enroll in Original Medicare or sign up for a Medicare Advantage plan, it’s important to understand what your Part D coverage entails and how it works.
At Benafica, it’s our goal to help you navigate your Medicare options, so together, we can find the plan that best meets your unique health care needs. Read on to learn what you need to know about Medicare Part D.
What Is Medicare Part D?
Medicare Part D is prescription drug insurance, which covers the cost of both brand-name and generic prescription drugs.
- Part D does not provide coverage for over-the-counter medications, such as cough syrup, antacids, and allergy drugs.
- Certain Part D plans also exclude coverage for specific prescription drugs, depending on the plan’s formulary.
Who Qualifies for Medicare Part D?
Medicare prescription drug coverage is optional. However, Part D plans are available to everyone who has Medicare.
To sign up for Part D, you must:
- Be age 65 or older (you can enroll beginning 3 months before your 65th birthday and for 3 additional months after you turn 65)
- Have a qualifying disability if you are not 65 years of age or older
- Have Medicare Part A or Part B, if are enrolled in Original Medicare
- Have Medicare Part A and Part B and live in the plan’s service area if you are enrolling in Part D as part of a Medicare Advantage plan or other Medicare health plan
Important Deadlines for Medicare Part D
As with any other Medicare plan, you can only enroll in Medicare Part D during specific times of the year. There are also specified date ranges during which you can change or drop your coverage.
Here are the deadlines you need to know:
- The 7-month period surrounding your 65th birthday
When you first become eligible for Medicare, you begin your initial enrollment period, during which you can sign up for Part D. If you sign up for prescription drug coverage outside of your IEP, you’ll typically pay a late penalty, which will be added to your monthly premium.
- October 15 to December 7
Each year, the Medicare open enrollment period occurs between these dates. During this time, you can enroll in a Part D plan, change your Part D plan, or drop your coverage entirely. However, dropping coverage may incur a penalty if you do not have any other form of prescription drug coverage.
- January 1 to March 31
This is the General Medicare Enrollment Period. During this time, you can change or drop your MA plan with Part D coverage. If you are enrolled in Original Medicare, you cannot join a Part D plan during this period.
- April 1 to June 30
If you have Medicare Part A and signed up for Part B for the first time during the General Enrollment Period, you can sign up for a Part D plan during this time. You can also choose to enroll in a Part C plan that includes Medicare prescription drug coverage.
How to Get Medicare Prescription Drug Coverage
To get prescription drug coverage under Medicare, you must sign up for a Medicare plan that offers it. There are two ways to do this:
- Sign up for a Part D plan. Enrolling in a Medicare Part D plan adds prescription drug coverage to Original Medicare, certain Medicare Private Fee-for-Service plans, certain Medicare Cost plans, and Medicare Medical Savings Account plans.
- Enroll in a Medicare Advantage plan. Signing up for an MA plan (Medicare Part C) that offers prescription drug coverage allows you to get Part A, Part B, and Part D coverage bundled into a single plan. You must be enrolled in Part A and Part B to sign up for an MA plan.
Remember that not all Medicare prescription drug plans pay for the same prescriptions. Because plans can vary the list of drugs they cover as well as the tiers they place those drugs into, it’s always best to speak with a knowledgeable, licensed advisor regarding your needs.
That said, all Part D plans must provide, at a minimum, the standard level of coverage set by Medicare.
Costs Associated With Medicare Part D
What you pay for Medicare prescription drug coverage varies according to your plan. If you’re enrolled in Original Medicare, you’ll pay a monthly premium for Part D in addition to the premium you pay for Part B. If you’re enrolled in a Medicare Advantage plan (Part C) that includes prescription drug coverage, your monthly premium will typically reflect a specific amount for drug coverage.
Your modified adjusted gross income may also affect the amount you pay for your monthly premium, but only if your MAGI is above a certain amount. Social Security will let you know whether your income requires you to pay a Part D income-related monthly adjustment amount (Part D IRMAA).
As mentioned, if you do not sign up for a Part D plan when you first become eligible for Medicare — even if you’re not taking any prescription drugs at that point — you’ll pay a penalty. However, you can avoid that penalty if you already have creditable drug coverage from another health insurance plan (from your employer, for example).
If you don’t have creditable drug coverage (coverage that’s equal to or greater than the standard level of coverage set by Medicare) it’s a good idea to enroll in a low-cost Part D plan when you first become eligible, just to avoid the penalty. If you need to change plans later, you can do so during the Fall Open Enrollment Period.
For more information on all things Medicare Part D, check out the Centers for Medicare & Medicaid Services’ Guide to Medicare Prescription Drug Coverage.
Need Medicare Enrollment Assistance? Contact Benafica
When it comes to enrolling in a Medicare Prescription Drug plan, there’s a lot to understand. At Benafica, we’re here to help you explore your options, so you can select the plan that best meets your health care needs.
When you have questions, our licensed advisors have answers, so feel free to schedule a free consultation with a representative today. You can also contact our St. Paul office at 651-287-3253 to speak with a representative directly.
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