Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to enroll in Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
Note: When completing the forms CMS-40B and CMS-L564
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employers signature and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
I Did Not Sign Up For Part D Prescription Drug Coverage When I Was First Eligible If I Want To Sign Up Now Is There A Penalty
En español | Part D late penalties are permanent and are calculated according to how many months you had delayed Part D enrollment. But whether youre liable for penalties depends on your situation.
You will not be liable for Part D late penalties in the following circumstances:
- If youve had creditable prescription drug coverage from elsewhere since enrolling in Medicare Part A and/or Part B, and you sign up with a Part D drug plan within two months of losing this coverage, youll avoid late penalties.
- If you receive Extra Help, a federal program that provides Part D drug coverage at low or reduced cost for people with incomes under a certain level, any late penalties are waived.
- If youve been living outside the United States, or have been incarcerated in prison situations in which you cant receive Part D drug coverage you avoid late penalties if you sign up with a Part D plan within two months of your return or release.
- If you delayed enrolling in both Part A and Part B at age 65, you were not eligible for Part D during that time because Part D requires enrollment in either Part A or Part B and therefore you cannot be penalized for late enrollment.
In all other situations, you are liable for Part D late penalties. Heres how theyre calculated: You pay 1 percent of the national average Part D premium in any given year, multiplied by the number of months youve been without creditable drug coverage since enrolling in Part A and/or Part B.
Medicare Supplement Insurance Plan
To enroll in a Medicare Supplement Insurance plan, please call us at $ $, $.
Aetna is the brand name for insurance products issued by the subsidiary insurance companies controlled by Aetna, Inc. The Medicare Supplement Insurance plans are insured by Aetna Health and Life insurance Company, Aetna Life Insurance Company, American Continental Insurance Company or Continental Life Insurance Company of Brentwood, Tennessee, all Aetna Companies. Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.
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When And How To Sign Up For A Part D Plan
May 18, 2020 By Garrett Ball
Prescription drugs are not covered by Original Medicare. You need to enroll in a stand-alone drug plan if you want drug coverage. These plans are run by private companies not the Federal Government, although they do get approved annually by CMS. You have the option to choose from many companies in the area/county in which you reside. This is called your service area. If you ever move out of your service area, then you will have to look for another prescription drug plan in your new location.
You can sign up for Medicare Part D during:
- Your IEP
- When you are about to turn 65, you have a seven-month period in which you can enroll in Medicare Parts A and B. This includes three months before you turn 65, your birthday month and three months after your 65th birthday.
- The AEP
- From October 15th to December 7th each year. You can change your prescription drug plan during this time frame. However, it will not go into effect until January 1st.
- If your birthday falls on the 1st of the month, the your seven-month period would start the month before your birth month. Lets say your birthday is on May 1st. Then your IEP will be from January 1 to July 31.
- Special Enrollment Periods such as:
- Losing credible drug coverage
- Losing drug coverage from an employer or union
- You are eligible for Extra Help
Note: If you get Extra Help, or live in a nursing home, you may change your Part D plan once a month.
In order to enroll in a drug plan, you are required to:
Which Medicare Part D Plan Is Right For You
Medicares free online tool enables you to search for plans offered in your area. You can enter the specific drugs you currently take and then get a cost comparison across plans based on each plans specific formulary, tier system, and whether they charge copays or coinsurance.
As noted earlier, if you opt for Medicare Advantage, your Part D coverage will most likely be included in the plan you choose. But here too you want to carefully comparison shop for the plan with the best drug coverage based on your individual needs. Hint: you and a spouse might choose different Medicare Advantage plans based on your medication needs.
Independent insurance agents that specialize in Medicare can also help you sort through all the moving pieces for plans offered in your area.. Free counseling is also available through your State Health Insurance Assistance Program .
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Delaying Part B Coverage And Late Enrollment Penalties
You should enroll in Part A when youre first eligible near your 65th birthday, but some people may choose to delay Part B.
If you receive group health insurance at work or through your spouses employer you may be able to delay enrollment in Part B.
But once you stop working or that coverage ends, you must sign up for Part B within eight months. Otherwise, youll face a late enrollment penalty.
If you enroll in Part B after your group health insurance ends, you have options for how to apply.
You can do so online through an application on the Social Security website or by mail.
How to Sign Up for Part B by Mail After Employer Health Insurance Ends
Medicare Part D Covers Prescription Drugs And Isnt Really Optional
Original Medicare includes only Parts A and B. That means if you take any prescription medications, or plan to and dont want to pay for them out of pocket youll need to add Medicare Part D to your coverage. This can be done as an add-on to Original Medicare or bundled with a Medicare Advantage plan. Medicare Part D premiums average about $33 per month, according to the CMS.
Signing up on time for Part D is especially important because theres a late-enrollment penalty if you miss your eligibility window. Medicare drug coverage can vary by medication, so start your research early to make sure your plan includes everything you need. Even if you dont take medication now, enrolling in Part D coverage can help prepare you for future prescription costs.
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You Can Sign Up For Medicare Part D During Your Medicare Initial Enrollment Period
This is the time when you can first enroll in Original Medicare . Many people are automatically enrolled in Original Medicare during their IEP when their Medicare age is nearing 65. But you typically wont be enrolled in a Medicare prescription drug plan at this time. For most people, the seven-month IEP begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month. Your IEP at your Medicare age of 65 is also when youre first eligible to sign up for Part D.
Medicare Parts A B & C
As a reminder, there are four parts of Medicare: A, B, C and D. Medicare Part A covers inpatient services, which includes hospital services that you receive as part of an overnight stay. Part B covers outpatient services, such as preventive care, doctor visits, and other medically necessary services.
Part A and Part B make up Original Medicare. Everyone is required to enroll in both parts, and even if you get a more comprehensive private plan, you will still need to pay for Parts A and B.
Medicare Part C, also called Medicare Advantage, is optional and itâs a private health insurance offered through Medicare. It works much like regular health insurance, but itâs generally less expensive because itâs part of Medicare.
Medicare Part C includes Original Medicare benefits plus some extras, usually including prescription drug coverage, known as a Medicare Advantage Prescription Drug plan. You usually donât need Medicare Part D if you have a Medicare Advantage plan.
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Some People Are Enrolled Automatically And Some Arent
If youre under the age of 65 and already receive Social Security benefits, you will be automatically enrolled in whats called Original Medicare. This includes Medicare Part A and Part B . Note that Medicare Part B carries a premium: Most people pay $170.10 per month in 2022, according to the Centers for Medicare & Medicaid Services, or CMS.
If youre not receiving Social Security benefits, you can during your initial enrollment window and choose which insurance combination is best for you.
Explore Your Other Medicare Coverage Options
Once you are enrolled in Original Medicare, you can explore additional coverage options.
You can decide to:
- Add a Medigap supplement insurance policy.
- Add a Part D prescription drug plan.
- Switch to a Medicare Advantage plan also known as Part C to replace your Original Medicare coverage.
Medicare Part D, Medigap and Medicare Advantage are all administered by private insurance companies that contract with CMS.
You can apply for these benefits online.
Use the Medicare Plan Finder tool to explore and compare plans in your area.
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Medicare Part D: Key Takeaways
- The only source of prescription drug plans is through private insurance companies.
- Most Medicare Advantage plans include prescription drug coverage.
- You can also purchase a stand-alone prescription drug plan if youre enrolled in a PFFS or MSA plan that doesnt include prescription coverage.
- Your first opportunity to enroll in Part D is when youre initially eligible for Medicare.
- You have the option of selecting an Advantage plan and using that in place of Medicare A, B, and D.
- In most cases, enrollment outside of your initial enrollment period is limited to an annual enrollment period.
- If you dont enroll in prescription drug coverage during your initial open enrollment and then enroll during a subsequent annual enrollment period, a late enrollment penalty will be added to your premium.
As of September 2021, more than 49 million Medicare beneficiaries had prescription drug coverage through Medicare Part D. The total is split nearly equally between those who have Part D coverage in conjunction with a Medicare Advantage plan , and those who have stand-alone Part D prescription drug plans , most of which are purchased to supplement Original Medicare.
But the balance has started to shift towards MAPD coverage, and it has recently surpassed the number of people with stand-alone PDP coverage .
Signing Up For A Medigap Policy
To purchase a Medigap supplement insurance policy, you must first enroll in Medicare Part A and Part B.
Medigap policies are not required but enrolling in one can help you pay out-of-pocket costs, including deductibles, coinsurance and copayments.
The best time to enroll in a Medigap plan is when you are first eligible.
This is a six-month enrollment period that begins the month youre 65 and enrolled in Medicare Part B.
If you apply for Medigap coverage after this six-month window, private insurance companies may not sell you a policy if youre in poor health.
You can find a Medigap policy by using an online tool on the Medicare website, contacting your local SHIP or calling your State Insurance Department.
How to Sign Up for a Medigap Policy Online
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If You Dont Sign Up For A Part D Prescription
Lisa F. Young
Question: In your article about Medicare, you mentioned the penalty for Part B if you dont sign up when youre first eligible. Isnt there also a penalty if you dont sign up for Part D prescription-drug coverage?
Answer: Youre right. You generally must sign up for Medicare Part D prescription-drug coverage when you first become eligible for Medicare at age 65 . You can sign up for Part D through a stand-alone plan or through a Medicare Advantage plan. But you arent required to sign up if you have creditable coverage from another source, such as drug coverage from an employer or retiree health insurance plan or from Tricare.
If you go for more than 63 days without creditable coverage, youll have to pay a late-enrollment penalty for every month you delay. The penalty equals 1% of the national base beneficiary premium times the number of months you didnt have Part D or creditable coverage. This penalty is added to your monthly Part D premium for as long as you have a Medicare drug plan. For example, if you didnt have Part D or creditable coverage for two years, your penalty would be $8.55 every month in 2017 . The national base premium changes every year, so your penalty can increase over time.
What Will I Pay For Part D Coverage
CMS has announced that the average Part D plan will cost $33/month in 2022. But the plans are issued by private insurers, and theres significant variation in terms of the benefits, the formularies and the pricing. Among the Part D plans that are available in 2022, premiums range from under $6/month to more than $207/month.
High-income enrollees pay extra for their Part D coverage. For 2022, the additional premiums range from $12.40/month to $77.90/month.
The premium adjustment for high-income enrollees is based on income tax returns from two years prior, since those are the most recent returns on file at the start of the plan year . Theres an appeals process you can use to contest the income-related premium adjustment if youve had a life-change event that has subsequently reduced your income.
In addition to the premiums, youll pay a copay or coinsurance for drugs. The donut hole in Part D plans has closed, thanks to the Affordable Care Act. It was fully closed as of 2020: Enrollees with standard Part D coverage now pay 25% of the cost of generic and brand name drugs while in the donut hole, which is the same percentage they pay before entering the donut hole.
Once you select a PDP, there are four ways to pay the premium:
- deducted from your personal account
- charged to credit or debit card
- billed monthly or
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Not Signing Up Because You Do Not Take Medications
Not everyone on Medicare takes medication. Even if they do, they may only take one or two inexpensive drugs that could cost less out of pocket than a monthly premium. It is no wonder people ask: If I do not take medications, why should I pay for prescription drug coverage?
For one, you never know what the future holds. Accidents and injuries could lead to unexpected health problems. You could have a disease that has not yet been diagnosed. Keep in mind that more than half of all Americans, regardless of age, have at least two or more chronic medical conditions. You could need prescription drug coverage in the future but you may not be able to predict when. It might be better to be safe and have prescription drug coverage than sorry and be without it.
Second, if you do not sign up when you are eligible for Part D, you may be subjected to late penalties later on. Paying more now could save you considerable money in the long run.
Recent Articles And Updates
For older articles, please see our article archive.
References
The 2010 Medicare Part D $250 Donut Hole Rebate. Q1Group LLC, .
2020 Part D Income-Related Monthly Premium Adjustment. . .
2021 Medicare Part D Outlook. Q1Group LLC, .
2021 Part D Income-Related Monthly Premium Adjustment. . .
How Do Medicare Advantage Ppo Plans Work? Healthline Media, May 5, 2021, .
Analysis of Part D Beneficiary Access to Preferred Cost Sharing Pharmacies . . .
Announcement of Calendar Year 2021 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. . .
Assistance with Paying for Prescription Drugs. Center for Medicare Advocacy, November 30, 2015, .
How Medicare Part D Works. AARP, October 2016, .
Medicare Advantage Special Needs Plans . Healthline Media, May 3, 2021, .
Kirchhoff, Suzanne M. Medicare Coverage of End-Stage Renal Disease . . .
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