Medicare Part D is prescription drug coverage. It is not included in Original Medicare (Medicare Parts A & B) but must be bought separately or as part of a Medicare Advantage Plan.
Why Medicare Part D Matters
Prescription drug coverage is a significant healthcare concern for mature adults. This concern can be profound for individuals with medical conditions or a family history of health problems.
Seniors who take prescription medication on a regular basis – or expect to – should consider Medicare Part D an essential piece of their insurance needs. They should also recognize that Part D is not automatically included in Medicare. It comes at an added cost or as part of a Medicare Advantage plan.
Am I Eligible for Medicare Part D?
Medicare Part D is only available to people who are eligible for Traditional Medicare.
To be eligible for Medicare coverage, one must pay into the program for 40 quarters (ten years) during the 20 years prior to retirement.
Those ten years do not need to be consecutive.
Seniors can enroll in Medicare, Medicare Part D and Medicare Advantage Plans on or around their 65thbirthday, and at other times during the year.
The Seven Month Enrollment Period for Medicare and Medicare Part D
You must enroll (or be already enrolled) in Medicare to enroll in Medicare Part D. Americans become eligible to enroll in original Medicare and Medicare Part D near their 65th birthday. The standard enrollment period begins three months before the enrollee’s 65th birthday, includes their month of birth, and then continues for three more months.
Some adults do not need to enroll for Medicare when they turn 65.
If you have health insurance through your employer (or your spouse’s employer), you can delay Medicare enrollment. This is known as “creditable coverage.”
Certain other conditions also trigger an SEP. For instance, if you move back to the US after living abroad, but have paid into the program, this will trigger an SEP.
Once you are eligible to enroll in Medicare, you have a choice between Original Medicare (plus Medicare Part D), or a Medicare Advantage Plan (sometimes called Part C).
Medicare Part D Formularies
Every Medicare Part D plan provider must give at least a standard level of drug coverage set by Medicare. Plans can vary though. The list of prescription drugs they cover (called a formulary) is different from one provider to the next.
For instance, antibiotics are a common type of prescription drug. All Medicare Part D providers must cover a few antibiotics. Still, there are over 100 antibiotics available in the US market. The precise medication covered will vary from one insurer to the next.
Every insurer that offers Medicare Part D must provide prospective customers with a copy of their drug formulary. Individuals who have allergies to specific medicines – or other special prescription needs – should read the formulary carefully. Otherwise, they may end up with a Part D plan that doesn’t meet their prescription needs. Once enrolled in a Medicare Part D plan, it can only be changed during certain times of the year.
Changing Medicare Part D: AEP and OEP Explained
There are two times during the year when Medicare enrollees can make changes to their Medicare Part D coverage: the AEP and OEP.
Medicare’s Annual Enrollment Period (AEP) occurs every fall. This is the time of year when a Medicare beneficiary can make changes to their plan. It starts on October 15 and continues through December 7.
During Medicare AEP you can:
Add Medicare Part D for the first time
Switch from one Part D plan to another
Cancel Part D coverage
Switch from Original Medicare to a Medicare Advantage Plan
Change from one Medicare Advantage Plan to another
Changes you make to your Medicare during the AEP will go into effect on January 1.
You can also make changes to Medicare Part D during the Open Enrollment Period (OEP). It begins on January 1 and continues through March 31 and will go into effect the first day of the month after you change your plan.
During OEP, you can:
Add or cancel a stand-alone Part D plan
Return to Original Medicare from a Medicare Advantage Plan
Or switch from one Medicare Advantage Plan to another.
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