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Medicare Prescription Drug Plans – FAQs


Medicare prescription drug plans also known as Medicare Part D is prescription drug insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

  1. Why should I get a Medicare prescription drug plan?
  2. Who can get Medicare prescription drug coverage?
  3. When can I get Medicare prescription drug coverage?
  4. What should I do before making a decision?
  5. How Do I Get a Medicare Prescription Drug Plan?
  6. How Much Does a Medicare Prescription Drug Plan Cost?
  7. What if I have a limited income and resources?
  8. How does Medicare prescription drug coverage work?
  9. Why is creditable coverage important?
  10. Are You Paying the Right Amount for Your Prescriptions?
  11. What should my costs be?
  12. What if I think I’m paying the wrong amount?
  13. Can I get any costs back if I’ve been paying too much?

Why should I get a Medicare prescription drug plan?

Medicare prescription drug plans provide greater peace of mind by protecting you from unexpected drug expenses. Even if you aren’t currently prescribed many prescription drugs, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future and avoiding any late Medicare prescription drug plan enrollment penalties.
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Who can get Medicare prescription drug coverage?

Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.  As long as you are enrolled in either Medicare Part A or Medicare Part B of Medicare.
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When can I get Medicare prescription drug coverage?

You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare benefits due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don’t sign up when you are first eligible, you may need to pay a Medicare Part D prescription drug late enrollment penalty. If you didn’t join when you were first eligible, your next opportunity will be during the Annual Enrollment Period.
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What should I do before making a decision?

Every year you have the opportunity to join or switch Medicare prescription drug plans. Your coverage will begin on January 1 of the following year. As you make a decision about your Medicare prescription drug plan, remember to do the following:

  • If you already have a Medicare prescription drug plan, review your current Medicare prescription drug plan benefits and costs as these are subject to change every year. Look at other plans in your area to see if one may be a better choice for you.
  • If you want to keep your current plan, you don’t need to do anything for your enrollment to continue. Sign up as soon as possible if you’re going to make a change. It will help you avoid any inconvenience at the pharmacy when you start using the new plan in January.  If you decide to make a change, your new enrollment into the new Medicare prescription drug plan will automatically discontinue your current coverage on the effective date.

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How Do I Get a Medicare Prescription Drug Plan?

To join a Medicare prescription drug plan, you must have Medicare Part A or Medicare Part B. You must also live in the service area of the Medicare prescription drug plan you want to join. There are several Medicare prescription drug plan administrators in your area, talk to one of our specialists to see which one will suit you best.
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How Much Does a Medicare Prescription Drug Plan Cost?

Each plan can vary in cost and which prescription drugs are covered. Your Medicare prescription drug plan monthly premium could be higher based on your income. This includes Medicare Part D coverage you get from a Medicare prescription drug plan, Medicare Advantage Plan, or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium.
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What if I have a limited income and resources?

There is extra help for people with limited income and resources. If you qualify for extra help, Medicare will pay for almost all of your prescription drug costs. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting www.socialsecurity.gov on the web.
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How does Medicare prescription drug coverage work?

Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or another Medicare Health Plan that offers drug coverage.
Whatever plan you choose, Medicare Part D drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.
Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan, and a yearly deductible which also varies by plan. You will also pay a part of the cost of your prescriptions, including a co-payment or coinsurance. Costs will vary depending on which Medicare Prescription Drug Plan you choose and what prescription drug you are purchasing. Some plans may offer more prescription drug coverage and additional prescription drugs for a higher monthly premium. If you have limited income and resources, and qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting www.socialsecurity.gov on the web
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Why is creditable coverage important?

If your current prescription drug plan is creditable coverage, you will not have to pay a late enrollment penalty (higher premium) if you wait to join a Medicare prescription drug plan after you’re first eligible. If your current prescription drug coverage isn’t creditable, you may want to consider joining a Medicare prescription drug plan. If you don’t have creditable prescription drug coverage and you wait to join a Medicare prescription drug plan until after you’re first eligible, your monthly premium will go up at least 1% for every month you waited to join. You may also have to wait to join a Medicare prescription drug plan during the Annual Enrollment Period.

Are You Paying the Right Amount for Your Prescriptions?

Getting “Extra Help” means Medicare will help pay your Medicare prescription drug plan costs, which includes help with paying your monthly premium, deductible, and co-payments.
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What should my costs be?

If you qualify for Extra Help, your prescription drugs will be no more than the maximum allowed by the Low Income Subsidy Program based on the level of assistance that you qualify for.  If you have Medicaid and live in an institution (such as a nursing home), you should pay zero for covered drugs. Most people who qualify for Extra Help also pay nothing for their monthly premium or annual deductible. However, some people with a higher income may pay a reduced monthly premium for their Medicare prescription drug plan.
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What if I think I’m paying the wrong amount?

Call your plan. Your plan may ask you to provide information to help them confirm the level of Extra Help you should get.

Here are some examples of documents you can send your plan to help prove you qualify for Extra Help:

  • A purple notice from Medicare that says you automatically qualify
  • A yellow or green automatic enrollment notice from Medicare
  • An Extra Help “Notice of Award” from Social Security
  • An orange notice from Medicare that says your co-payment amount will change next year
  • If you have Supplemental Security Income (SSI), you can use your award letter from Social Security as proof that you have SSI

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Can I get any costs back if I’ve been paying too much?

If you have paid for your Medicare prescription drug plan or your prescription drugs since the date you qualified for Extra Help, you may be able to get back some of these costs. Keep the receipts, and call your Part D Plan for more information.

Our goal is to find you the best Medicare prescription drug plan with the lowest monthly premium, the lowest deductibles, the lowest co pays, and most importantly minimizes your exposure to the “donut hole” or gap in coverage.

If you want to make more specific plan comparisons based on what matters to you, you can get personalized information from the Medicare Prescription Drug Plan Finder. The Medicare Prescription Drug Plan Finder can be accessed at www.medicare.gov.
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