How Do You Enroll In Medicare Part D

How To Get Prescription Drug Coverage

Medicare drug coverage helps pay for prescription drugs you need. It’s optional and offered to everyone with Medicare. Even if you dont take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when youre first eligible, and you dont have other creditable prescription drug coverage or get Extra Help, youll likely pay a late enrollment penalty if you join a plan later. Generally, youll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.

You Automatically Get Medicare

• You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
• We mailed you a welcome package with your Medicare card.

Sign up for Part B if you live in Puerto Rico or outside the U.S.

• Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.

• Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.

Delaying Medicare Part D Coverage

If you delay Medicare Part D without creditable drug coverage, youll incur a Medicare Part D Late Enrollment Penalty in addition to your Medicare Part D premium each month.

As we grow older, our chances of needing prescriptions will often increase. If you have no creditable prescription drug coverage, you should enroll when youre first eligible.

For many seniors, taking prescription drugs on a regular basis is not optional. Patients who have regular medication needs should be sure to enroll as soon as their Medicare Part D eligibility begins.

Unexpected or not, the cost of medications can be financially exhausting. Medicare Part D plans allow you to pay less for the same quality medications.

Take Bob for example, Bob had never taken prescription drugs in his life. So, he did not enroll in Medicare Part D. However, one unexpected prescription could have financially devastated him.

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Is Original Medicare More Expensive Than Medicare Advantage

Your premiums may be higher with Original Medicare. You could have higher monthly premium payments with Original Medicare than with Medicare Advantage, because you might want to add a Part D prescription drug plan or other additional coverage. You may pay more copays with Medicare Advantage than with Original Medicare.

What Is The Medicare Part D Late Enrollment Penalty

Its a good idea to sign up for a Part D plan when you become eligible, even if youre not taking any prescription medications. Why? Medicare adds on a permanent 1 percent late enrollment penalty to your premiuif you dont enroll within 63 days of your initial eligibility period.

The penalty rate is calculated based on the national premium rate for the current year multiplied by the number of months you didnt enroll when you were eligible. So, if you wait, your extra penalty payment will be based on how long you didnt have PartD coverage. This can add up.

The base premium changes year to year. If the premium goes up or down, your penalty changes, too.

If you have a Medicare Advantage plan, when you turn 65, you still need to have Part D coverage.

You can avoid the penalty if you have Medicare from another plan. This means you have drug coverage thats at least equal to the basic Medicare Part D coverage from another source, like an employer.

Since the penalty can add to your premium cost, it makes sense to buy a Part D plan at low cost when you become eligible. You can change plans during each open enrollment time if you need different coverage.

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D Spending And Financing

Part D Spending

The Congressional Budget Office estimates that spending on Part D benefits will total $119 billion in 2023, representing 14% of net Medicare outlays . Part D spending depends on several factors, including the total number of Part D enrollees, their health status and drug use, the number of high-cost enrollees , the number of enrollees receiving the Low-Income Subsidy, and plans ability to negotiate discounts with drug companies and preferred pricing arrangements with pharmacies, and manage use .

Part D Financing

Financing for Part D comes from general revenues , beneficiary premiums , and state contributions . The monthly premium paid by enrollees is set to cover 25.5% of the cost of standard drug coverage. Medicare subsidizes the remaining 74.5%, based on bids submitted by plans for their expected benefit payments. Higher-income Part D enrollees pay a larger share of standard Part D costs, ranging from 35% to 85%, depending on income.

Payments to Plans

After You Apply For Medicare Part D

Once youve applied, the plan has 10 calendar days to reply in one of three ways:

• Confirming theyve received your application
• Requesting more information
• Denying your application with an explanation why.

If you merely receive confirmation, you’ll soon get a card in the mail with important documents about your plan details. If they need more information from you, send it to them ASAP. If they’ve denied you, it’s either because you’re not in the plan’s service area or you’re not currently in an enrollment periodget more information about these reasons and try again for another plan.

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What If I Miss Open Enrollment For Medicare Advantage

You may want to make Medicare Advantage changes at midyear if youre prescribed a new medication not in your present plans formulary or want to see a doctor not in its provider network. You have several opportunities to switch Medicare Advantage plans or leave Medicare Advantage after open enrollment is over:

• Anyone in a Medicare Advantage plan can choose another Advantage plan during this time, also known as the Medicare Advantage open enrollment period. Or you can leave Medicare Advantage for original Medicare and join a Part D plan. Your new coverage begins the first day of the month after you switch. You cant get a Medicare Advantage plan during this time if you dont already have one.

Be aware: If you leave Medicare Advantage for original Medicare and want a Medigap policy to help cover Medicares deductibles and copayments, this supplemental coverage may not be guaranteed. Medigap insurers can charge more or reject you because of preexisting conditions unless you buy a Medigap policy during certain times.

• During your first year of Medicare Advantage. You can change to original Medicare any time during this one-year trial. You also can sign up for a Part D prescription drug plan and qualify for a special enrollment period to get Medigap coverage regardless of preexisting conditions.

Keep in mind

If you dont already have a Part D or Medicare Advantage plan, sometimes you can sign up outside of open enrollment, such as:

Do I Have To Sign Up For Medicare Part D

Its not required for you to have Part D coverage. That said, if you currently need or anticipate needing to spend a significant amount of money on drugs in the future, you should really consider enrolling. The Medicare prescription drug benefit may be a good decision for you. Think about your current drug coverage, your income and how much you currently spend on prescription drugs before you choose a drug prescription plan.

Some states have a pharmaceutical assistance program that helps with the costs of Part D coverage as well. However, you will already have to be enrolled in Part D coverage to get this help. If your income is falls within the eligibility guidelines, then you can enroll in Medicare Part D and get a plan that is nearly free. The government pays for most of the drug costs if you qualify for Extra Help based on your income. Also, if you sign up for a prescription drug plan and qualify for Extra Help, then you dont have to pay a premium penalty for late enrollment.

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Do I Need To Enroll In The Same Medicare Plan As My Spouse

There is no need to join the same Medicare Part D plan as your spouse. Medicare is an individual health plan, there are no joint plans. When choosing a Part D plan it is important to consider your individual health needs. While one plan may work well for you, it may not work for your spouse.

Do I have to enroll in Medicare Part D to keep Original Medicare ?

No. Enrollment in a Medicare Part D plan is optional. However, to enroll in a prescription drug plan you must first enroll in Original Medicare or a Medicare Advantage Plan.

Where can I get help with choosing a Part D drug plan?

Before enrolling in a Medicare Part D drug plan, it is important you feel comfortable with your decision. There are various resources you can utilize to gather more information, like Medicare.gov and The Medicare Rights Center to name a few. Another way to get help choosing a Part D drug plan is by consulting with an independent licensed insurance agent. Medicare Concierge can help connect you with an licensed insurance agent or direct you to online resources to enroll online. Independent licensed insurance agents represent multiple plans which allow them to give an unbiased opinion on your health plan choices. Because they represent many carriers, they have a better understanding of how each plan compares to the next. Most independent licensed insurance agent services are free, so there is really no downside to using their services.

Are There Late Enrollment Penalties

There is a late enrollment penalty if you fail to sign up for prescription drug coverage when you first become eligible. The penalty comes in the form of an increased premium once you do sign up for a plan.

The Part D penalty goes into effect if there is ever a period of 63 days or more where you dont have drug coverage. The penalty is calculated by taking 1% of the national base beneficiary premium and multiplying it by the number of months you went without drug coverage.

How is Your Part D Penalty Calculated?

• Step 1: Find the national base beneficiary premium.
• Step 2: Take 1% of the base beneficiary premium.
• Step 3: Multiply the number of months you didnt have drug coverage by that 1% figure.

Your penalty can change year-to-year as the national base premium is recalculated. You typically must continue to pay the penalty for as long as you have drug coverage.

There is a way to avoid the penalty even if you didnt sign up for Part D. Beneficiaries are exempt if they can show that in the interim, they had drug coverage that was equal to or better than a Part D plan. A common example would be health insurance that you have through an employer.

Medicare Part D Made Easy

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How Much Is The Part D Penalty

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The national base beneficiary premium may change each year, so your penalty amount may also change each year.

How Do You Enroll In Medicare Part D

When enrolling in Part D, it is important to make sure that you have considered all your options. Be sure to compare the plans in your area, both for costs and formularies. If there is a certain medication you need or expect to need one day, its important to make sure that it is covered.

Medicare offers a plan finder tool that can help you locate plans available in your area. You also should compare different providers near you to look into things like how well they are rated and how their customer service is.

You should also be sure to compare whether it makes more sense for you to purchase a stand-alone plan or switch entirely to Medicare Advantage. Depending on the plans available near you and your personal health needs, each option can make sense for you.

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Am I Eligible For Part D

Medicare prescription drug coverage is an optional benefit offered to people who have Medicare. If youre enrolled in Original Medicare Part A and/or Part B, you can get Part D regardless of income. You dont need to have a physical exam and you cannot be denied for health reasons. Part D is also a part of some Medicare Advantage plans.

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.

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When Will My Medicare Begin

In most situations you can receive Medicare disability benefits once you receive Social Security disability income benefits for 24 months. Medicare disability coverage begins the 25th month. The 24-month period begins the month you are entitled to receive Social Security disability benefits. In some cases this could be earlier than the month you receive your first disability benefit check. A person who has ALS and is under age 65 can get Medicare benefits the first month he or she is entitled to SSDI or railroad retirement disability benefits. If you have ESRD , you are eligible for Medicare benefits:

• the first month you start to administer a regular course of dialysis treatment after receiving selfcare training, or
• the fourth month you receive treatment at a dialysis center , or
• the month the transplant is done or the month of hospitalization as an inpatient up to two months before the transplant, if pre-transplant testing has begun.

Medicare Advantage Plans May Cost You Less

If you enroll in a Medicare Advantage plan, you must continue to pay your Medicare Part B premiums and you may pay an additional premium. The insurer determines the Medicare Advantage planâs premium, which can vary from one Medicare Advantage plan to another. Some Medicare Advantage plans may offer enrollees monthly premiums as low as $0.

Your cost sharing may also be less under Medicare Advantage. For, example, if an enrollee visits a primary care physician under Medicare Advantage, they may have a copayment of $10. However, if the enrollee visits a primary care physician under Original Medicare, they may have a coinsurance of 20%, which could be more than $10.

Also, a Medicare Advantage plan limits your maximum out-of-pocket expense. Once you have spent that maximum, you typically pay nothing for covered medical services for the remainder of the year. Original Medicare does not provide a maximum out-of-pocket cap, so potential expenses are limitless.

Often a Medicare Advantage plan can be less expensive than comparable coverage with Original Medicare. To get the most out of a Medicare Advantage plan with Original Medicare, you may also need to enroll in a stand-alone Medicare Part D Prescription Drug Plan as well as a Medicare Supplement Insurance plan.

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How Do I Change My Medicare Coverage

Your Medicare choices are not set in stone after the first time you enroll. You can make changes to your Medicare coverage during a few special Medicare enrollment periods.

• The Medicare Annual Enrollment Period , October 15 December 7
• The Medicare Advantage Open Enrollment Period, January 1 March 31
• The Medicare Special Enrollment Period for qualifying life events dates vary based on qualifying event

Learn how to make changes to your Medicare coverage during these three time periods: