How To Apply For Extra Help With Medicare Part D
If you qualify for Part D Extra Help eligibility, your options to enroll, change, or leave a plan are identical to dually eligible beneficiaries. If youre no longer eligible for Extra Help for the following year, you will have a 3-month window to change plans. This period starts either the date youre notified or when youre no longer eligible whichever happens first.
Beneficiaries that have Medicaid also get Extra Help covering the costs of prescriptions. However, Medicare beneficiaries without Medicaid may still be eligible for medication assistance.
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
How To Choose A Medicare Part D Plan
Choosing the right planor deciding to switch from the plan you currently haveis not an easy choice. Nor is it one to make lightly. But there are a few steps you can take to make this process as smooth and beneficial as possible.
First, youll want to learn what Medicare Part D prescription drug plans are available to you. Medicares official website has an online service called the Prescription Drug Plan Finder. If you enter some personal information, it can provide you with a list and contact information for all Part D drug plans sold where you live. It can also help you sort through them by matching the drugs you take regularly and the plans lists of covered drugs.
Sorting through different prescription drug plans and choosing the best one for yourself or for someone youre caring for can be confusing, even after doing your research. If you dont feel comfortable making the decision on your own, you can get free, expert personalized help from the nonprofit State Health Insurance Assistance Program , in some states called the Health Insurance Counseling and Advocacy Program . The counselors at a local SHIP or HICAP office have experience with the plans offered in that geographic area. Go to Medicares list of contacts for each states SHIP or HICAP central office, which can then direct you to the local office nearest you.
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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 .
When Your Coverage Starts
The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.
If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65.
Part B : Coverage starts based on the month you sign up:
If you sign up:
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Recent Articles And Updates
For older articles, please see our article archive.
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 . . .
There Are 2 Ways To Get Medicare Drug Coverage:
1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private FeeforService plans, and Medical Savings Account plans. You must have
to join a separate Medicare drug plan.
with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.
To join a Medicare drug plan, Medicare Advantage Plan, or other Medicare health plan with drug coverage, you must be a United States citizen or lawfully present in the United States.
Visit Medicare.gov/plan-compare to get specific Medicare drug plan and Medicare Advantage Plan costs, and call the plans youre interested in to get more details. For help comparing plan costs, contact your State Health Insurance Assistance Program .
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Through A Private Insurance Company
Different insurance companies and even some pharmacies offer online resources to compare Part D plans. Keep in mind these tools may be tailored to their own plans. You can apply online through the plans website, by contacting the insurance company by phone, or by visiting a local insurance agency.
Remember you will need your Medicare identification number and the starting dates of your Medicare coverage to complete your applications.
How To Apply For Medicare Part D Online
Prescription drug coverage is important for many older adults, especially those who rely on monthly prescription medications. With so many plan options available, finding the right coverage for your needs can be overwhelming. The good news is, you dont have to go at it alone. There is help available! Working with a licensed independent insurance agent to apply for Medicare Part D online ensures you receive the best prescription drug coverage for your needs. The best part, help is completely free! Keep reading to find out what you need to know about applying for Medicare Part D online with a licensed insurance agent.
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Introduction To Medicare Part D
This section constitutes an introduction to Part D. For more detailed information on any of the topics in this section, please click on the links within the topics. There, you will also find relevant legislative, statutory and CFR citation.
Prior to 2006, Medicare paid for some drugs administered during a hospital admission , or a doctors office . Medicare did not cover outpatient prescription drugs until January 1, 2006, when it implemented the Medicare Part D prescription drug benefit, authorized by Congress under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This Act is generally known as the MMA.
The Part D drug benefit helps Medicare beneficiaries to pay for outpatient prescription drugs purchased at retail, mail order, home infusion, and long-term care pharmacies.
Unlike Parts A and B, which are administered by Medicare itself, Part D is privatized. That is, Medicare contracts with private companies that are authorized to sell Part D insurance coverage. These companies are both regulated and subsidized by Medicare, pursuant to one-year, annually renewable contracts. In order to have Part D coverage, beneficiaries must purchase a policy offered by one of these companies.
The costs associated with Medicare Part D include a monthly premium, an annual deductible , co-payments and co-insurance for specific drugs, a gap in coverage called the Donut Hole, and catastrophic coverage once a threshold amount has been met.
How Do You Know If Your Application Was Accepted
Since Part D plans are provided by private insurers and not the federal government, there is no standardized way to check the status of your application or whether or not it was accepted.
You will likely need to reach out to the private insurance company you have purchased the plan through to check your status as an applicant.
The plan provider should notify you once your application has been approved. If time has passed and you havent received an update, then you should reach out to the insurance company by calling them or checking their website.
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How To Get Prescription Drug Coverage
Medicare drug coverage helps pay for prescription drugs you need. Even if you dont take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. 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.
Not Shopping Around For Plans
Part D plans may be regulated by the federal government but they are run by private insurance companies. These companies are for-profit and can charge you whatever they want with the following exceptions. The government limits how much they can charge you in deductibles each year. Also, you cannot be charged more than 25 percent of the cost of your drugs, or the actuarial equivalent. Beyond that, premiums, copays and coinsurance are in their hands.
The governments quality standards for Part D plans assure you have access to a wide range of medications. However, each insurance company can charge a different amount for the same drugs based on negotiations they have made with pharmaceutical companies.
It is in your best interest to shop around for Part D plans. Whether you choose one that offers the lowest cost on your medications, costs you less in premiums or provides donut hole coverage, there is sure to be a plan out there for you. You just have to seek it out every year.
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When Can I Apply For Medicare Part D
There are two main enrollment periods for Part D coverage: Medicare Initial Enrollment PeriodThe Initial Enrollment Period is the seven-month period around your 65th birthday when most people are eligible for the first time to enroll in Medicare. and Open Enrollment.The Medicare Open Enrollment Period , also known as the Annual Enrollment Period, runs from October 15 to December 7 each year and allows you to make multiple Medicare-related changes. In addition, Affordable Care Act Open Enrollment allows changes to non-Medicare coverage from November 1 to December 15. You can also enroll during the Special Enrollment PeriodA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. if you qualify. Lets take a look at the specific dates for when you can enroll.
How To Pay For Part D
After youve signed up, youll pay monthly Part D premiums to the insurance company. You may either receive bills or sign up for automatic payments. You also may be able to request that your premium be deducted from your monthly Social Security or Railroad Retirement Board payment.
Medicare beneficiaries with low incomes and few assets may qualify for the federal Extra Help program that givesfinancial assistance to pay for Part D premiums, deductibles and copayments.
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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.
The Part D Standard Benefit
At a minimum, plan sponsors must offer a standard benefit package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, previously referred to as the Donut Hole. Sponsors may also offer plans that differ from but are actuarially equivalent to the standard benefit. Finally, they may also offer enhanced plans that provide benefits in addition to the standard benefit. Typically, the enhanced plans offer some coverage during the Donut Hole.
The Standard Benefit is defined in terms of the financial structure of the cost-sharing, not the drugs that must be covered under the plan.
Medicare does not establish premium amounts for plans. Instead, premiums are established through an annual competitive bidding process and evaluated by CMS. Premiums vary from plan to plan and from region to region. Medicare does establish the maximum deductible amount, the Initial Coverage Limit, the TrOOP threshold, and Catastrophic Coverage levels every year. The table below shows the standard benefit for this year .
Standard Part D Benefit 2020-2021
Alternatives to the Standard Benefit
Income-Related Monthly Adjustment Amount Part D
Income-Related Adjustments 2021
|Greater than or equal to $500,000||Greater than or equal to $750,000||$77.10|
The Donut Hole
Once beneficiaries reach their out-of-pocket threshold costs), they move out of the Donut Hole and into Catastrophic Coverage.
The Donut Hole Discount
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You Are 65 And Signing Up For Medicare Parts A And B
You can join a Medicare prescription drug plan during your Initial Enrollment Period.
Your IEP is 7 months long. It starts 3 full months before the month you turn 65. It continues through the month of your 65th birthday, and then for another 3 full months.
Example: You turn 65 on June 5. Your IEP starts on March 1 and ends September 30 .
If you are enrolling during your IEP, your coverage will start at the following times:
- If you are 65: the first day of the month after you ask to join a plan
- If you are under 65: the first day of the month you turn 65
How To Apply For Medicare Part D
Our comprehensive guide helps you find the best Part D drug plan for you
Although Medicare is not without its faults, one thing is clear: Medicare Part D has been a successful program. With nearly 70% of all beneficiaries enrolled in Part D, this optional add-on to Original Medicare is a popular way to lower drug costs.1
But before diving into the deep end of Part D plans, youll want to perform due diligence to get the best plan for your needs. In this guide, well walk you through how to research and then successfully sign up for a Part D plan.
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Is It Mandatory To Have Medicare Part B
While Part B is optional, penalties can be high if you wait too long. Part B covers physician visits, lab tests, outpatient surgeries, and even Durable Medical Equipment.
If you choose to delay Part B you can pay up to 10% above the standard premium for a period of every 12 months that you dont carry coverage. Also, the more time that passes the higher the penalty.