The Basics of Medicare - Part D
What is Medicare Part D?
Medicare offers outpatient prescription drug coverage (Medicare Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other company approved by Medicare. Once you choose a Medicare drug plan, you may join by completing a paper application, calling the plan, or enrolling online. If you want Medicare drug coverage, you need to choose a plan that works with your health coverage.
You can get your Medicare prescription drug coverage either through Medicare Prescription Drug Plans, which add drug coverage to original Medicare, or through Medicare Advantage Plans that include Medicare prescription drug coverage.
What if I already have other prescription drug coverage?
If you have another source of drug coverage, such as through an employer or union, you should check with your current provider to determine how your coverage compares to Medicare Part D. Unless your other drug coverage is considered “creditable” coverage, meaning that it is at least as good as Medicare prescription drug coverage, it’s important for you to join a Medicare prescription drug plan when you are first eligible. Postponing enrollment may mean higher premiums due to a penalty that you will have to pay as long as you have Medicare prescription drug coverage.
How much does Part D cost?
Most people will pay a monthly premium for Medicare prescription drug coverage. You will also pay a share of the cost of your prescriptions, including a deductible, co-payments, and/or coinsurance. Your costs will vary depending on the drugs you use, the plan you choose, and whether you go to a pharmacy in your plan’s network. If you have limited income and limited resources, Medicare Part D’s Extra Help or Low-Income Subsidy program can help you receive full or partial financial assistance to pay for premiums, deductibles, and co-payments.
When can I join, switch, or drop a Medicare Part D Plan?
You can join, switch, or drop a Medicare Part D prescription drug plan at these times:
- When you first become eligible for Medicare.
- Between October 15 and December 7 each year. Your coverage will begin on January 1 of the following year.
- Special Enrollment Period – In certain situations, including if you involuntarily lose your creditable prescription drug coverage, you may get a Special Enrollment Period. You can sign up for Part D and won’t have to pay a late enrollment penalty as long as you join a Medicare drug plan within 63 days of losing your creditable coverage.
- If you are eligible for and receive the extra financial help for Part D costs, you have a continuous Special Enrollment Period and can change your Medicare drug plan at any time.
Note: Between January 1 and February 14 each year, you can join a Part D plan if, during this period, you dis-enrolled from a Medicare Advantage Plan and returned to Original Medicare. Your coverage will begin the first of the month after the plan receives the enrollment form.
How do I qualify for the Extra Help?
You automatically qualify for the Medicare Part D extra financial help if you have Medicare and Medicaid, Medicare and Supplemental Security Income (SSI) without Medicaid, or if the state helps pay your Medicare premiums. If you don’t automatically qualify, you may qualify for the Extra Help if you meet certain income and resource guidelines that change each year. For 2012, the income limit for a single person is $1,361 in monthly income and $12,640 in assets. The amount for a married couple is $1,839 in joint monthly income and $25,260 in joint assets.
How can I get more information about my Medicare benefits, Medicare Advantage plans, Medigap plans, the Extra Help or about Medicare Part D prescription drug plans?
Call the Senior Health Insurance Counseling Program (SHIP) at LIFE Senior Services, sponsored by the Oklahoma Insurance Department at (918) 664-9000 or (866) 664-9009 for unbiased, up-to-date information on your Medicare benefits and assistance in applying for the Extra Help with drug plan costs and selecting a Part D plan. You may also contact Medicare toll-free at 1-800-MEDICARE (800-633-4227) or visit Medicare’s website at www.medicare.gov.
The Basics of Medicare | Part A | Part B | Part C | Part D
