Medicare Part D

Medicare Part D

Medicare’s Open Enrollment Period begins on November 15th and ends December 31st. Medicare.gov is the official website for all Medicare coverage information.

Applying for Medicare Part D? It’s not to late if:

  1. You turn 65 after December 31, 2008.
  2. You qualify for Medicare’s Low Income Subsidy Assistance.
  3. You move out of your plan’s service area.
  4. You and your spouse are both enrolled in Medicare and Medicaid.
  5. You live in, or move into or out of an institution (like a nursing home).
  6. You have creditable prescription drug coverage and that coverage ends.

Frequently Asked Questions

Do I have a choice?

Most importantly, you have a choice. All Medicare plans are run by private companies, which release the details of their plans after October 1 of each year. Although all plans must meet the government’s requirements, there will be differences between plans, including what drugs are covered and what pharmacies you can use. For example, some plans offer mail-order service. At the end of the year, you can re-evaluate your plan and select a different one if you aren’t happy with your current plan.

Plans come in two basic types. The simplest is a prescription drug plan (sometimes called a PDP), which covers only drugs and can be used with your traditional Medicare and/or a Medicare supplement plan. The second type combines a prescription drug plan with a Medicare Advantage plan. This includes medical coverage for doctor visits and hospital expenses. This kind of plan is called a Medicare Advantage plus Prescription Drug, or MA-PD.

Am I eligible?

Part D plans are open to everyone who’s eligible for Medicare in the U.S. and U.S. territories. Usually, that means people who are 65 years old or older, though some younger people with certain disabilities are eligible too. You cannot be denied coverage for health reasons and participation is voluntary. You get to decide if you want to enroll or not. If you have Medicare and Medicaid, you will be enrolled automatically, so there is no lapse in your Medicaid prescription drug coverage. The open enrollment period is November 15 to December 31, for coverage beginning January 1. There will be annual enrollment periods from then on. If you decide to join later, your monthly premiums may be higher because there’s an additional fee for late enrollment.

Do I pay to participate?

Participation in Medicare Part D does come with a cost and you will pay a portion of it. Typically, the government pays about 75 percent of the enrollment costs of the plan and you pay the rest.

Are prices discounted if I apply?

When you join a Part D plan, and use the plan’s network of pharmacies, you have access to discounted prices on drugs. Plans will negotiate lower prices with drug companies and pass those savings along to you. So when you pay for drugs within the plan, even when you are responsible for 100 percent of the payment, you have access to discounted rates.

What happens if I enroll late?

If you did not enroll when you were first eligible, you may pay more. The late enrollment fee is approximately one percent of your premium for each month you delay, and you’ll pay it for as long as you stay in a Part D plan. If you’re late because you were participating in a qualified prescription drug plan, such as a plan from your former employer, the fees may not apply to you. Or if you are eligible for the Low Income Subsidy, the fees may not apply to you. If you have drug coverage through the Veterans’ Administration (VA), and are enrolled in Medicare, you can still obtain your prescriptions through the VA.