What Does Medicare Part D Cost
Like Medicare Advantage plans, Part D stand-alone plans will also vary in costs based on the plan you choose. Each plan negotiates prices with drug manufactures and pharmacies. Your copays and coinsurance rates are based on these prices and on guidelines set by Medicare. You can find explanations of specific drug costs in each Part D plan’s Summary of Benefits or Evidence of Coverage materials.
Your total prescription drug costs will also be impacted by the number of prescriptions you take, how often you take them, if you get them from an in-network or out-of-network pharmacy, and what Part D coverage stage you are in. Your costs may also be less if you qualify for the Extra Help program.
First, let’s look at what kinds of costs you could pay for Part D, then dive into the different coverage stages and how they work.
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Can I Enroll In Medicare Part D After My Initial Enrollment Period
In most cases, enrollment outside of your initial enrollment period is limited to an annual enrollment period between October 15 and December 7, with coverage starting January 1 of the following year. During this time, you can switch to a new PDP or Medicare Advantage plan, and coverage is guaranteed issue. The new plan will automatically replace the old one, so you dont need to do anything other than enroll in the new plan.
If you are enrolled in a Medicare Advantage plan and want to switch to Original Medicare, you can do so either during the fall open enrollment period or during the Medicare Advantage open enrollment period . If you do so, youll also have the option to purchase a Part D plan at the same time, so that youll have prescription coverage to go along with your Original Medicare coverage.
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Changing Or Canceling Your Plan
Life is full of twists and turns. You could be faced with new health challenges. Your financial situation could change if you retire or lose your job. Your insurance company could make changes to your plan. All of these things could affect how much prescription drug coverage you need and how much you can afford.
You may need to consider changing your Part D plan. The good new is you are not stuck with the same Part D plan forever. You have choices. The trick is to know when to make those changes.
Ready To Apply For Medicare Part D
Ready to apply? Check out Medicare’s plan finder or just give us a call. We’ll be happy to help guide you through the process.
1. Kaiser Family Foundation, 10 Things to Know about Medicare Part D Coverage and Costs in 2019″
Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency . Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.
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Medicare Part D Special Enrollment Period
Medicare Part D Special Enrollment Periods occur when certain situations or events happen in life. Special Enrollment Periods give you a chance to make changes to your current Medicare Part D plan or enroll in a Medicare Part D plan outside of a typical Medicare Part D enrollment period. However, to enroll in a plan for the first time, you must meet all other Medicare Part D eligibility requirements.
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Several events can trigger a Special Enrollment Period. These include changing where you live, becoming eligible for new coverage outside of Medicare, losing your current coverage, changes to your current plans contract with Medicare, and other special situations.
Changes you make during a Special Enrollment Period will go into effect on the first of the following month.
When Can I Join A Part D Prescription Drug Plan Or Switch Plans If I Already Have Coverage
En español | Medicare covers many of your health care expenses, but it doesnt provide prescription drug coverage.
You have two ways to get coverage: Buy a stand-alone Part D prescription drug plan, or sign up for a Medicare Advantage plan that combines medical and drug coverage. Private insurance companies that Medicare regulates offer both types of plans. Keep in mind, you can enroll only during certain times:
Initial enrollment period, the seven-month period that begins on the first day of the month three months before the month you turn 65 and lasts for three months after the birthday month.
Open enrollment period, which runs annually from Oct. 15 to Dec. 7, with coverage beginning Jan. 1. You also can switch to a different Part D or Medicare Advantage plan during this time.
Medicare Advantage open enrollment period, which runs from Jan. 1 to March 31 each year. During this time, if you already have a Medicare Advantage plan, you can switch to another plan with prescription coverage. But if you switch to a Medicare Advantage health maintenance organization or preferred provider organization without drug coverage, make sure you have coverage from a retiree plan, Tricare or another option because you wont be permitted to buy a separate Part D plan. Or you can leave Medicare Advantage and return to original Medicare and buy a stand-alone Part D plan. The changes take effect the first day of the following month.
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What Happens If Medicare’s Contractor Decides The Penalty Is Wrong
If Medicares contractor decides that all or part of your late enrollment penalty is wrong, the Medicare contractor will send you and your drug plan a letter explaining its decision. Your Medicare drug plan will remove or reduce your late enrollment penalty. The plan will send you a letter that shows the correct premium amount and explains whether you’ll get a refund.
What If You Get Certain Benefits Or Other Help To Pay Prescription Costs And Medicare Automatically Enrolls You In A Plan
If you have other prescription drug coverage that’s at least as good as Medicare’s drug coverage , you may not want to keep the drug plan Medicare enrolls you in. If you don’t want to keep this plan, or to have Medicare enroll you in another drug plan, call 1-800-MEDICARE , 24 hours a day, 7 days a week, or the plan provider. TTY users should call 1-877-486-2048. Tell them you want to disenroll from this plan .
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Changing Part D Plans: The Final Steps
After youve found your new Part D plan and figured out the scheduling with enrollment periods, the rest of the process is pretty simple. You can enroll in your new plan either through Medicares online plan finder tool or by contacting the plan directly. Youll need the following information:
- Your Medicare number
- The policy and group numbers of your current plan
- The dates you want changes to take effect
More good news: You dont have to cancel your old Part D plan. The new plan will give your information to Medicare, then Medicare will inform your soon-to-be-canceled plan. That coverage will automatically end when your new coverage begins.
What New Part D Plan Should You Choose
In 2021, Medicare Part D plans are covered by every state, but the availability of plans varies by state. Narrowing so many choices down to your top contenders can be time-consuming. Medicares online plan finder tool makes plan comparison much easier. When youre searching for a new plan, consider these factors:
- What drugs are you currently taking? Look at each plans formulary to estimate costs.
- If you prefer generic drugs, find a plan with a tiered pricing system that offers low pricing on generic brands.
- If youre not currently taking many medications, a plan with a low monthly premium could be right for you. This way youll still have the peace of mind that your medications will be covered if you need them in the future.
- If you want to keep your drug costs steady throughout the year for budgeting reasons, opt for a plan with a low or no deductible.
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Can I Avoid The Donut Hole
The main way to not hit the coverage gap is to keep your prescription drug costs low so you don’t reach the annual coverage gap threshold. … And even if you do reach the gap, lower drug costs and forms of assistance may help you pay for prescriptions you still need, even if they aren’t covered at the time.
Are You Eligible For A Part D Special Enrollment Period
Aside from the two main enrollment periods, certain circumstances may entitle you to a special enrollment period when you can change your Part D plan. These circumstances include:
- If You Move to an Area Where Your Current Part D Plan Isnt Available If you notify your current plan before you move, your SEP begins the month before you move and ends two full months after you move. If you notify the plan after you move, your SEP begins the month you notify your plan and ends a full two months after that notification.
- If You Move to a New Area Where Your Current Plan Is Still Available But Now Have Additional Part D Options That You Didnt Have Before Your SEP period will remain the same if you move to an area where your current plan isnt available.
- If You Currently Live in a Skilled Nursing or Long-Term Care Facility, or You Move Into or Out of One Your special enrollment period lasts as long as you live in the facility and for two full months after you move out.
- If Your Plan Changes Its Contract With Medicare Medicare will determine your special enrollment period on a case-by-case basis.
There are several other circumstances that could qualify you for a special enrollment period. The full list is on Medicare.gov.
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For People With Both Medicaid And Medicare
The Medicare Modernization Act of 2003 added prescription drug benefits for Medicare beneficiaries and is known as Medicare Part D. Medicare Part D offers prescription drug coverage through Medicare. A Medicare Part D eligible individual is one who is entitled to or enrolled in Medicare benefits under Part A and/or Part B.
Dual eligibles are people who have both Medicare and Medicaid.
Dual eligibles receive their prescription drug coverage through Medicare rather than through the Medicaid program. Medicare Part D replaces Medicaid as the pharmacy coverage for dual eligible enrollees.
If enrollees do not participate in a Medicare prescription drug plan, they may lose all their Medicaid benefits. However, some people on Medicare and Medicaid may receive a letter from their employer or union stating that if they enroll in Medicare Part D they will lose the health care benefits provided by the union or employer. If an enrollee has received this letter, they may disenroll from the Medicare Prescription Drug program by calling 1-800-MEDICARE . They must also give a copy of this letter to their Medicaid worker in order to continue receiving Medicaid benefits.
Changing Part D Plans During Open Enrollment
You can sign up for a Medicare Part D plan or switch from one Part D plan to another during each years open enrollment period.
You also can sign up for a Medicare Advantage plan or switch to a different Medicare Advantage plan with or without drug coverage during that time. Coverage in your new plan begins Jan. 1.
Even if youve been happy with your Part D plan, comparing your options during open enrollment every year is a good idea. Medicare prescription drug plans can change coverage and costs from year to year. Type your zip code, drugs and dosages into the Medicare Plan Finder to find the total cost for every plan available in your area, including premiums and copayments for your specific medications.
If you have prescription drug coverage through a Medicare Advantage plan, you have an extra opportunity to switch to another Medicare Advantage plan or change from Medicare Advantage to original Medicare and join a Part D plan during Medicare Advantage open enrollment each year. You can make one change during that period.
Be aware: If you decide to leave a Medicare Advantage plan for original Medicare, you may not have a guaranteed right to buy a Medigap policy to help cover original Medicares out-of-pocket costs if more than six months have passed since you signed up for Medicare Part B. Check with your State Health Insurance Assistance Program to find out whether an insurer could reject you or charge you more for preexisting conditions.
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How To Enroll In Medicare Part D
Once you decide if you want to enroll into a Medicare Prescription Drug Plan or a Medicare Advantage plan that includes drug coverage, you can apply directly through the insurance company.
Generally, you should be able to enroll by submitting a paper application, calling the plan, or enrolling online. You may also enroll through a licensed insurance agent such as eHealth. Medicare Part D Prescription Drug Plans arenât allowed to call and ask you to enroll into their plan.
When you enroll in prescription drug coverage, you will have to provide your Medicare number and the date your Medicare Part A and/or Medicare Part B coverage started. You can find this information on your Medicare card.
What Is The Late Enrollment Penalty
The Late Enrollment Penalty is a fee that is meant to encourage enrollment in a prescription drug plan at the point of eligibility. If you are enrolled in a Medicare prescription drug plan, you may owe a Late Enrollment Penalty, if for any 63 days or more after the Initial Enrollment Period, you went without 1 of these:
- A Medicare Part D Prescription Plan
- A Medicare Advantage Plan
- Another Medicare health plan that offers Medicare prescription drug coverage
The Late Enrollment Penalty is added to your monthly Part D premium for as long as you have Part D coverage, even if you change your Medicare Part D plan. The Late Enrollment Penalty amount changes each year. You may also have this penalty if you have a Medicare Advantage plan that includes prescription drug coverage . You can avoid the late enrollment penalty by making sure you enroll when you are eligible and keeping your coverage.
If you qualify for Extra Help due to a lack of income or resources, you can enroll late without a penalty. However, if you lose Extra Help, you may be charged a penalty if you have a break in coverage.
Medicare, not the Cigna Part D Plan, will determine the penalty amount. You will receive a letter from the plan notifying you of any penalty. For further questions or concerns about the Late Enrollment Penalty, call Medicare at 1 MEDICARE or visit www.medicare.gov
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Staying With The Same Plan Every Year
We live in a world of convenience but health care is not one of the times to cut corners. Your Part D plan will approach you for renewal every year. Take a close look at your situation. Has anything changed in the past year? Do you take more medications now or anticipate taking more medications in the year to come? Will your plan cost you more the next year? Is it worth the added cost?
Just because your Part D plan worked well for you one year does not mean it will be the best plan for you the next. Do some research and make sure you pick the Part D plan that will give you the best coverage for your dollar.
Changing Part D Plans Outside Of Open Enrollment
You may qualify for a special enrollment period to change your Part D plan in certain situations at other times during the year:
If you receive financial assistance from the Part D Extra Help program, you can change Part D plans as often as once each calendar quarter during the first three quarters of the year. Extra Help helps people with low incomes and assets pay Part D premiums and copayments.
If you move into, live in or leave a nursing home or long-term care facility, you generally can join or switch Part D plans. And after you move out, you can take two additional months to decide if you want a different plan.
If you move outside your current drug plans service area, you usually have up to two months to switch to a new Part D or Medicare Advantage plan.
If your current Part D plan terminates its contract with Medicare, you have up to two months before and one month after the plans Medicare contract ends to go to another plan.
If a five-star Part D or Medicare Advantage plan covers your area, you can switch into that plan once any time of the year, except for the first week in December. You can use this special enrollment period for plans that have earned an overall five-star rating from the Centers for Medicare & Medicaid Services once a year. Coverage begins the first day of the month after the plan receives your enrollment request.
Keep in mind
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