Medicare is the government health insurance program that offers health coverage for hospital care and medically related services. It also has a program that provides for outpatient prescription drugs.
That program is known as Medicare Part D.
Unlike Parts A and B, or “Original Medicare,” which primarily provide hospital coverage and medical services, and have been central to the program since its inception in 1965, Medicare Part D was enacted as part of the Medicare Modernization Act of 2003, and went into effect January 1, 2006. Part D is considered “optional” coverage and can help Medicare beneficiaries pay for self-administered prescription drugs through insurance premiums. Today, nearly one in eight Americans, or 42 million seniors and disabled individuals, rely on it.
There are two basic ways to enroll in Medicare Part D. You can enroll through a stand-alone prescription drug plan in conjunction with “Original Medicare”, which currently comprises about 60 percent of all Part D enrollees, or as part of a Medicare Advantage plan.
For those enrolled in “Original Medicare”, the only source of a prescription drug plan is through a private insurance company, as Medicare Part A and B do not cover outpatient prescriptions. Medicare Advantage, or Part C, allows enrolleesto receive their Medicare benefits through a private health insurance plan, as opposed to receiving them through Parts A and B. Since the main point of Medicare Advantage is that it offers more coverage options than “Original Medicare”, prescription drug plans are for the most already included. If not, enrollees can purchase a stand-alone plan.
Either way, the first opportunity to enroll for prescription drug coverage is when a senior is initially eligible to enroll in the full Medicare program. This occurs during a seven-month Initial Enrollment Period beginning three months prior to an eligible senior’s 65thbirthday month.
Enrollment outside of an Initial Enrollment Period is limited to Medicare’s Annual Open Enrollment period between October 15 and December 7, with coverage starting January 1 of the following year. The enrollment periods and rules are the same for stand-alone plans and Medicare Advantage plans.
It can be confusing to find both the right plan to meet your health care needs and to ensure that it is offered in your geographic location. To help seniors, Medicare offers a “Plan Finder Tool” that allows them to compare and contrast, and ultimately select, the best drug plans for their needs. You can access it by clicking this link to the Medicare website.
After you’ve chosen the right plan for your needs, you can get started by:
Calling 1-800-MEDICARE to locate available drug plans in your area
Logging in to Medicare’s Prescription Drug Plan Enrollment Center
Filling out the paperwork sent by mail from Medicare
Calling the private insurer with the specific drug plan you want to join.
We know this article may raise more questions than it answers. Do not wait to call our office to get the information you need both now and in the future! We are here to support you and your loved ones.
