What is Medicare Part D?
Medicare Part D is another federal insurance program like Medicare Parts A and B. The program is designed to help you minimize your out-of-pocket expenses for prescription drugs. Medicare Part D is not like Medicare Parts A and B. Instead of enrolling for Part D coverage through Social Security or Railroad Retirement Benefits offices, you choose from Part D plans available in your area through private insurance carriers approved by the Federal Government.
What Does Medicare Part D Cover?
Medicare Part D is designed to help lower your out-of-pocket costs for your prescription drugs. When you choose a Part D plan through a private insurance provider in your county, you automatically enroll for Medicare Part D.
With Part D of Medicare, you need to make monthly premium payments to the insurance provider. The insurance company offers you substantially lower copays on the prescription drugs you would have to pay for entirely without Medicare Part D.
Enrollment for Medicare Part D
Medicare Part D is an optional program. However, it might be necessary for you to purchase one to lower the costs of medicine you will need. Enrolling in Part D is advisable if you will rely primarily on Medicare for your health care costs. It is possible for you to enroll for Medicare Part D directly through an insurance carrier, but enrolling through an agent specializing in Medicare, offers you an additional resource to answer any questions you might have about the drug plan. It is also possible to enroll in Medicare Part D directly through Medicare’s website or by calling 1-800-MEDICARE.
It is important to remember that most Medicare Advantage plans also include Medicare Part D coverage. You can only enroll with one Part D insurance program at a time, so it is crucial to check whether a Medicare Advantage plan you are considering offers coverage for the medication you need.
Medicare Part D enrollment is possible only in certain timeframes. You can qualify to enroll in Medicare Part D when you first enroll in Medicare. Your Initial Enrollment Period (IEP) spans seven months from when you first enroll for a Medicare plan. Medicare Part D and Part C also has an annual election period starting from October 15 and lasts till December 7. You can enroll, disenroll, or change from any Part D or Medicare Advantage plan during the election period each year. Each September, your insurance provider will mail you an Annual Notice of Change that provides you a list of all the changes in your plan effective from January 1 of the coming year, giving you the opportunity to change your drug plan based on the changes. If you do not change your drug plan, your insurance provider will automatically renew your Part D for the next year.
Please note that there are two enrollment periods each year.
October 15 to December 7 is called the Annual Enrollment Period (AEP), applicable for all plans and people new to Medicare. Changes to the plans take effect on January 1 of the next year.
January 1 to March 31 is the Open Enrollment Period (OEP), often called the Advantage OEP. This enrollment period allows you to switch from a Medicare Advantage plan to Original Medicare, a Part D plan, or switch to another MAPD or MA plan. The OEP is not applicable to people with only Original Medicare or a Part D plan. It is only for those who enrolled, switched a plan during the AEP, or People with special election period.
Medicare Part D Special Election Periods
Enrollment into a Medicare Part D plan means you have to stick with the plan for the remaining calendar year. To change your drug plan, you will need to wait for the next Annual Election Period. Of course, some people might require an exception to the Annual Election Period so they can change their plan earlier. Medicare has Special Election Periods designed to cater to such individuals.
SEPs are created when you find yourself in situations where you might need to change your plan. For instance, moving to another state or losing your group medical coverage in the middle of the year can create a SEP.
Please note that the SEP is not created only when you lose your creditable coverage or when you move. There might be other situations that create SEPs, like if you are enrolled in any Federal or State program like LIS, PAAD, or Medicaid that gives you the chance to make changes as SEPs. However, the rules for when and the type of changes you can make vary greatly for each SEP.
How to Choose a Medicare Plan
Choosing a suitable Medicare plan can get overwhelming. There are several considerations you need to make when you start searching for the right Medicare plan for you. Understanding the differences between Original Medicare and Medicare Part C and D. Once you grasp how the two plans work, there are a few questions you can ask to figure out which plan suits your needs better:
- What insurance do your preferred care providers accept?
- Do you frequently travel out of state?
- Do your primary physicians participate in Medicare Advantage plans or only accept Original Medicare?
These are some of the considerations you need to keep in mind. Choosing the right Medicare plan despite figuring out answers to these questions.
