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MEDICARE PART D HAS MANY OPTIONS
Who Can Get Medicare Drug Coverage?
To join a Medicare Prescription Drug Plan, you must have Medicare Part A and/or Part B. If you would like to get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.
If you have employer or union coverage, call your benefits administrator before you make any changes, or before you sign up for any other coverage. If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health (doctor and hospital) coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependants.
Four Steps to Get Medicare Prescription Drug Coverage
To help people with Medicare take advantage of the new Medicare prescription drug coverage, there are four steps you can think about while making a decision:
1. Getting Started
The decision to get Medicare prescription drug coverage depends on how you pay for your drugs now and how you get your Medicare coverage. Most people with Medicare pay for drugs and get their Medicare in one of five ways:
Original Medicare only, or Original Medicare and a Medigap (‘Supplement') Policy without drug coverage. The new Medicare drug coverage will cover half of the costs for you if you have this kind of coverage now. Enhanced options are available that provide more coverage.
Original Medicare and a Medigap (‘Supplement') Policy with drug coverage. The new Medicare drug coverage will generally provide much more comprehensive coverage at a lower cost.
Retiree or union coverage. In most cases, people with good retiree or union coverage can continue to get it, with new financial support from Medicare.
Medicare Advantage Plan (like an HMO or PPO) or other Medicare Health Plans that offer Medicare prescription drug coverage. You get all your Part A and Part B coverage and prescription drug coverage (Part D) through these plans.
Dual coverage from Medicare with Medicaid drug coverage.
2. Determining what matters most and reviewing plan options
Once you decide that you want prescription drug coverage, think about what matters most to you. There are a range of plan options available, so you can focus on the kind of coverage you prefer. There are two ways you can get your Medicare drug coverage. You can add drug coverage to the traditional Medicare plan through a “stand alone” prescription drug plan. Or you can get drug coverage and the rest of your Medicare coverage through a Medicare Advantage plan, like an HMO or PPO, that typically provides more benefits at a significantly lower cost through a network of doctors and hospitals. No matter what type of plan you choose, you can choose a plan that reflects what you want in terms of cost, coverage and convenience.
What you pay for the coverage, including premiums, deductible, and payments for your drugs.
What benefits are provided (like coverage in the “coverage gap” and other coverage enhancements), which drugs are covered and the rules (like prior authorization) for getting those drugs.
Check with the plan to make sure that the pharmacy of your choice is a provider for the plan. If you spend part of the year in another state, see if the plan will cover you there. You can get information about the specific drug plans in your area by visiting www.medicare.gov
or calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. This resource helps you find Medicare prescription drug plans by state or Medicare Advantage plans with prescription drug coverage by county. It lets you see the plans in your area that offer drug coverage, including basic information to help you find ones that meet your needs based on cost, coverage, and convenience.
3. Choosing a plan
There are many ways to choose a plan. You may rely on advice from people you know or trust, or choose a plan you are already familiar with, or get information about specific drug plans in you area by visiting www.medicare.gov
or calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. To reach the Medicare help line call 1-800-MEDICARE, TTY 1-877-486-2048. Medicare customer service representatives will provide information and answer your questions For additional information and assistance in Ohio one can call the State Health Insurance Assistance Program (SHIP) at 1-800-686-1578. For additional information and assistance in Connecticut one can call the Aging Services Division at 1-866-218-6631
4. You can join, switch, or drop a Medicare drug plan at these times:
• When you are first eligible for Medicare (the 7 month period that begins 3 months before the month you turn age 65, includes the month you turn age 65, and ends 3 months after the month you turn age 65).
• If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability. You will have another chance to join 3 months before the month you turn age 65 to 3 months after the month you turn age 65.
• Between November 15–December 31 each year. Your coverage will begin on January 1 of the following year, as long as the plan gets your enrollment request by December 31.
• Between January 1 - March 31 of each year if you already have Medicare prescription drug coverage.
• Anytime, if you qualify for Extra Help or if you have both Medicare and Medicaid.
In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans during a special enrollment period (like if you move out of the service area, lose other creditable prescription drug coverage, or live in an institution).
For help with questions about eligibility for and enrolling in Medicare, Social Security retirement benefits, or disability benefits you can call the Social Security Administration at 1-800-772-1213, TTY 1-800-325-0778.