How to signup for Medicare Part D is easy. Although, you may need to know the terms to fully understand the concept. It is essential to comprehend how it works as a whole. Moreover, grasping the big picture will make it easier. This includes Medicare part D requirements and Medicare Part D plans.
People define Medicare as a federal health insurance program. This program is for people aged 65 or older. Also, signup for Medicare Part D is available for people under 65 with specific disabilities. For example, people who have end-stage renal disease (ESRD). The people who pay taxes and the federal budget fund this program.
Furthermore, it is helpful to understand the different Medicare parts. These are Part A, B, C, and D Medicare. These different elements help cover medical services which you may need as a senior. Also, there is a difference between Original Medicare, and Part C Medicare. This will be discussed further.
Original Medicare is directly administered by the federal government. In fact, this is how most people get their coverage. It includes Part A and Part B Medicare.
Part A Medicare (Hospital Insurance)
Part A helps cover the basic medical needs. It is also referred to as Hospital Insurance. Coverage includes inpatient care in hospitals. Also, it covers skilled nursing facility. In addition, it has hospice care and home health care.
This is free for most people. However, you will have to pay Social Security Taxes for about 10 years. Meanwhile, if you haven’t paid taxes or worked for a shorter time, you may have to pay an additional monthly premium.
Part B Medicare (Medical Insurance)
Also called Medical Insurance, this covers certain services. It covers doctor services and other health care providers. Moreover, it includes home health care, outpatient care and laboratory tests. Furthermore, it includes mental health care and some durable medical equipment. Part B also covers some preventive services.
Part C Medicare (Medicare Advantage Plan)
Part C is another way of getting coverage. This is run by Medicare-approved private insurance companies. It includes benefits and services under Part A and B. Although, they provide their own costs, rules and restrictions. Some insurance companies also cover Part D Medicare.
Moreover, anyone can automatically enroll. Their former or current employer, union may cover Part C Medicare. In fact, they may stay or switch to Original Medicare. Medicare Advantage Plan is a wide concept that you must also understand.
Part D Medicare (Medicare Prescription Drug Coverage)
Basically, Part D Medicare covers prescription drugs. Just like Part C, it is run by Medicare-approved private insurance companies. Signup for Medicare Part D adds coverage to Medicare. For this part, you pay monthly premiums for this coverage. Significantly, it covers and lowers drug costs and it protects seniors from expensive medical costs.
You can purchase Medicare Part D plans from private companies. This is added coverage to Original Medicare. Also, to other Medicare Cost Plans. You may signup for Medicare Part D through their Medical Coverage Plan. However, only if your plan includes drug coverage. Otherwise, you may have to join a separate Medicare Prescription Drug Plan.
How To Signup For Medicare Part D?
You can signup for Medicare Part D. This can be done during the Initial Enrollment Period. Of course, you have to be enrolled in Part A and/or Part B Medicare. Also, you have to live in your plan’s area.
Medicare Part D is usually run by insurance companies approved by Medicare. Further, each plan varies in costs and drug coverage. There are two ways to signup for Medicare Part D.
- Medicare Prescription Drug Plan (Part D) – This plan adds drug coverage to Original Medicare. Sometimes, people call it “PDPs.” Some add this to Medicare Cost Plans. Also, Medicare Private Fee-for-Service (PFFS) Plans. And, Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plan (Part C) – This is like HMO or PPO. Mostly, Medicare health plans offer Medicare Part D. Part C may cover Part A, B, and D coverage. In fact, this plan including prescription drug coverage is called “MAPDs.” Moreover, one must have Part A and B to join Medicare Part C.
It is also possible to get extra help for Part D.
Part D Eligibility and Enrollment
Eligibility for Part D is easy. You may also enroll in MAPD which means Medicare Advantage Prescription Drug Plan. People can signup for Medicare Part D during these certain times:
Initial Enrollment Period (IEP for Part D)
This period is when one is eligible for MAPD. Usually, it overlaps when seniors are first eligible for Medicare. This begins three months before they turn 65. It includes their birth month and ends three months later. Lastly, it is a total of seven months.
People under 65 with disabilities are also eligible. This period begins three months before their 25th month of disability benefits. Social Security or Railroad Retirement Board provides this. Likewise, this lasts for seven months.
Annual Election Period (October 15 to December 7)
This is the yearly period. Further, this is the opportunity to make changes in one’s Part D coverage. Also, AEP is the best to signup for Medicare Part D. That is, for those without Part D. Moreover, they may enroll in a MAPD plan for the time. Otherwise, they may switch plans.
Switching From Part D to Part D Enrollment Period (January 1 to February 14)
This period is for those who wish to switch from Part C to Original Medicare. Also, they may use this time for Part D enrollment. However, this cannot be used to make changes in Part D coverage.
Selection Election Period
It is also possible to signup for Medicare Part D outside the periods above. They may enroll in Part D or make changes to their coverage. That is, if they qualify for a Special Election Period. For example, if one qualifies for SEP but does not include moving out of their plan’s service area. Also, they cannot lose their Medicaid eligibility. Lastly, they cannot move into another nursing home.
Medicare Advantage Prescription Drug Plans (MAPDs)
It is also possible to signup for Medicare Part D when one is under Medicare Advantage Plan. Also, agents call this Medicare Advantage Prescription Drug Plans (MAPD). This helps anyone get their prescription drug coverage under a single plan.
Furthermore, Medicare-approved companies can only provide these plans. Also, they differ in costs and availability. In addition, Medicare Part D Plans depend on the company and location. Those who will enroll in Part C must take their prescription drug coverage from the same plan. Therefore, they must inform their provider if they wish to switch.
Medicare Part D Costs
Most Medicare Part D requirements charge monthly fees. This also varies by plan. People may pay this in addition to Part B premium. Having Part C which includes prescription drug coverage means paying an amount for drug coverage.
Premiums and Annual Deductibles
One must contact their drug plan or social security. That is for those who want their premium deducted from their salary. Usually, the first deduction happens three months. Likely, deductions for 3 months of premium happen at once. After that, deductions occur each month. One may also see delays in premiums if one switches plans.
Furthermore, one must continue to pay for Part B premiums. This is in addition to monthly Medicare Part D premium.
Deductible is the amount one pays each year for their prescriptions. Also, this is before their drug plan begins to pay their share of drugs. Moreover, deductibles vary between drug plans. No plan may have a deductible of more than $400. In fact, some Medicare Part D Plans do not have deductibles.
Moreover, deductibles are the out-of-pocket one pays for their prescriptions. This occurs before initial coverage begins.
Initial Coverage (Copayments or Coinsurance)
The amount one pays for their prescriptions is either copayment or coinsurance. This occurs after they pay the deductibles. Well, if their plan has one. Also, other prescription drug plans have distinguished levels or “tiers.” These tiers of copayments have different costs for different types of drugs.
Usually, the amount they pay for prescriptions is a one-month supply of a drug. However, they may request less than a month of supply. This is for most types of drugs. Moreover, they may do this if they’re getting a new medication. Also, the new medication may have significant side effects. Or, they may want to synchronize the refills for their medications.
If this happens, there will be a reduction on the amount. The basis is the quantity they actually get. One may contact their insurance to get a prescription for less than one-month supply.
One may get drugs at an out-of-network pharmacy. They pay the in-network pharmacy copay or percent of the cost. In addition, they pay the amount where the out-of-network pharmacy charges are higher.
Take note: if one receives extra help, the benefits do not apply. Typically, one only has to pay a low copay.
Coverage Gap “Donut Hole”
Most Medicare drug plans include coverage gaps. Agents refer to this as “donut hole.” This defines a temporary limit on which the drug plan covers.
Also, not everyone enters the coverage gap. This gap begins after the insured and the plan has paid a certain amount. For instance, when one has spent $3,700 on drugs then they are in the coverage gap. Moreover, this amount changes annually. In addition, people with Medicare may get extra help. Extra help pays Part D costs and will not enter coverage gap.
Once a senior spends $4,950 out-of-pocket in 2017, they are out of the coverage gap. Once they get out of that, they automatically get “Catastrophic Coverage.” This assures they only pay a small coinsurance. Or, a copayment for covered drugs for the rest of the year.
Basically, this plan pays most of the cost of a covered drug. Typically, one pays a small amount not more than 5% of the cost. They will stay in this payment stage until the end of the calendar year. In addition, not everyone reaches this phase.
Prescription Drug Formulary and Tiers
Understanding Medicare Part information helps one save money. Further, one must know how their prescription drug coverage works. Seniors must know terms such as drug tiers and formularies. What do words covered medicines and uncovered medicines mean? Also, what do seniors really need to know? Further, how do tiers and formularies affect how much they will pay?
Every insurance company has formularies. This is a list of medicines with approval. These insurance help pay for those drugs. Remember, one will have to meet deductibles first before their plan starts helping.
Further, signup for Medicare Part D covers only certain medicines. Sounds restrictive isn’t it? But actually, it may help lower one’s payment for medicines. There are a myriad of medicines available. In fact, a lot of them treat the same conditions. However, they do it in slightly different ways. And for different costs.
The insurance company works together with expert doctors and pharmacists. This allows them to come up with the best and effective medicines. These safe medicines will be included on their formulary. Moreover, a Medicare drug formulary must include number of options. These must help treat specific conditions.
Knowing Your Tiers
Formularies are divided into levels. Agents commonly refer to them as “tiers.” These tiers determine the costs of the medicine. Also, the people pay depends on the tier their medicine is in. Further, they pay each time they fill a prescription.
Mostly, insurance companies have five tiers. Others have four. Nevertheless, it may be similar as to the comparison chart below:
Knowing Which Tier One’s Drugs Are In
Your plan’s drug list will help you determine which tier your drugs are in. This is the easiest way. When one looks up a drug, the second column of the list shows which tier it is in. Further, the plan’s Summary of Benefits is the section for the drug costs. This section may also be Evidence of Coverage. Moreover, this section breaks down one’s coinsurance or copay for each drug tier.
What The Medicine is Non-Preferred?
Sure, it does not sound good. However, one may ask their pharmacist to work with their insurance company and doctor. They may help find a less expensive generic. Further, they may help find a preferable alternative. Actually, it may be safe and effective. But, it could cost less.
An Insurance Plan’s Formulary May Change
Most insurance plan’s formulary changes throughout the year. New medicines, benefits and lower costs may enter the market. Sometimes, they may take a drug from the list. It is essential to know that there is a better or lower cost alternative.
For example, if a doctor decides on a medication that isn’t on the list. They may always request authorization from the insurance company. Then, the company sees if they can help pay for it.
Signup for Medicare Part D will provide the essential prescription drug benefits. Although, the plan can be confusing. The right education is the key to understanding Medicare Part D plans. Further, Seniors must take note of deadlines.
Using generics and drugs under low tiers add savings. Further, they lower the chance the plan lands in coverage gap. All Part D plans have a formulary or drug list. This list meets guidelines according to law. However, not all plans have the same formulary. Moreover, the costs vary depending on the tier. Those considering Part D must review the plan’s formulary. It ensures they meet the prescription drug coverage needs.