Medicare Part D | Prescription Drug Coverage

Medicare open enrollment periods happen annually, and are the period in which you can make various changes to aspects of your coverage. For 2019 coverage, enrollment ran from October 15, 2018, to December 7, 2018. This is the period in which you can switch from Original Medicare to Medicare Advantage, or the other way around. Open enrollment dates for 2020 coverage are yet to be announced, but as soon as they are, we will publish them, along with any updates to this article.

There are 2 main ways to get your Medicare coverage – Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Original Medicare doesn’t cover everything, so many people buy additional coverage, like a Medicare Prescription Drug Plan (Part D) or a supplemental Medigap Policy.

Medicare provides optional prescription drug coverage to anyone who has Medicare. However, it’s important to consider whether you’ll opt for Part D coverage upon first enrolling in Medicare. If you decide not to get Medicare drug coverage when you’re first eligible, more likely than not you’ll have to pay late enrollment penalties. And you’ll have to pay this penalty for as long as you have Part D prescription drug coverage.

Are There Exceptions?

Two exceptions to late enrollment penalties are:

1. You have other creditable prescription drug coverage

2. You qualify for Extra Help

How to Enroll

To opt into Medicare Part D prescription drug coverage, you need to join a plan that’s Medicare-approved and that offers Medicare drug coverage. Plans vary by both cost and drugs covered. That’s why it’s extremely useful to consult with your pharmacist, who can review your medication history, help you anticipate which drugs you’ll need in the upcoming year, and assist you in assessing plans, co-pays — and ultimately finding the best plan for your unique needs.

After selecting a Part D drug plan, there’s a path to follow in order to join it. You need to:

Information to Provide

When joining your Part D drug plan, provide them with your Medicare Number and the date your Part A and/or Part B coverage started. You can locate this information on your Medicare card.

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Consider Your Options

It’s important to consider all your prescription drug coverage options. If you have supplemental insurance, through the Department of Veterans Affairs, TRICARE, or insurance through your employer; consider what drugs those plans cover, how much you pay for them, and compare that with what you determine to be the best Part D plan for you. Again, drug coverage can change from year-to-year, so it’s important you review those changes and reassess what makes sense for your unique situation.

You should also be aware that enrolling in Part D may affect your Medicare Advantage coverage. In certain circumstances, your Part C plan will disenroll you and you’ll go back to Original Medicare coverage.

That happens when both of the following apply:

During the year, your medical needs may have changed. You may now be taking medications you weren’t anticipating when you enrolled the previous year. Or perhaps a drug that was once covered by the plan you chose is no longer covered in the new year. The best time to switch prescription drug plans (Part D) is during the open enrollment period.

Switching Plans

If you want to switch plans, you should do so as soon as possible to avoid delays in getting your prescriptions filled, and so that you have your new card as soon as your membership begins. If you switch plans, you’ll get a letter in the mail from your new Medicare drug plan, and that letter will inform you of when your coverage begins.

*Play it safe and avoid scams: don’t give away personal information to an insurance provider that calls you, unless you’re a member of that plan.

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Dropping Your Part D Plan

After reviewing plans, consulting with your pharmacist, and anticipating the year to come, you may find it’s in your best interest to forgo the optional Medicare Part D plan. The time to do this is during the Open Enrollment Period. When you drop your existing plan, it’s not required that you join a new plan.The change will go into effect on January 1 of the following year.

If you choose to drop your Medicare Part D (prescription drug plan) during the Open Enrollment period, you can do so by following one of these options:

Where Can I Find My Plans Contact Information?

Typically, your plan’s contact information can be found on your membership card. Alternatively, you can find the contact information for your plan online through Medicare.gov. Open enrollment is so critical because you won’t be able to drop your plan outside that time frame unless you meet certain criteria.

After dropping a Part D plan, you can rejoin a plan in the future. However, it’s important to note that if you go 63 consecutive days or more without other creditable prescription drug coverage, you’ll have to wait for the next enrollment period to sign up for coverage and may experience late enrollment penalties.

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What is Covered by Medicare Part D?

Every Medicare Part D drug plan has a unique list of covered drugs, commonly referred to as a formulary. Frequently, Medicare drug plans will place various drugs into “tiers” on their formularies, with drugs in each tier having a different cost.

For example, a medication that falls in a lower tier will typically cost less to the patient than a drug in a higher tier. In many cases, your prescriber might think you need a medication that’s in a higher tier. If that’s the case, it is possible for you or your doctor to ask your plan for an exception, qualifying you for a lower co-payment.

Within certain guidelines, it is possible that Medicare drug plans will make changes to their formularies during the year. If the change involves a drug you’re currently taking, you have rights.

Before changing the tier of a drug you’re prescribed, your plan must do one of these:

Medicare Safety Checks

For certain drugs, Medicare Part D plans could add additional safety checks, and will alert your pharmacy for review prior to your prescription being filled. Safety alerts may happen in circumstances like:

Prior-Authorization

Some plans may require a “prior authorization” to ensure certain drugs are used correctly and only when medically necessary. In other words, before your plan will cover certain medications, you will be required to demonstrate to the plan that you meet the criteria for you to have that particular drug.

Other rules might include:

When you use a drug plan for the first time, you must bring with you to the pharmacy three items:

1. Your red, white, and blue Medicare card

2. Photo ID

3. Your plan membership card

What to Expect

Within 2 weeks after your plan receives your finished application, you should receive a letter informing you they got your information. Within 5 weeks, you should receive a welcome package that will include your membership card. If you go to the pharmacy before your card arrives, you can use any of the following as proof of membership:

*If you don’t have any of these, we might be able to get your drug plan information using your Medicare Number or the last 4 digits of your Social Security Number. If for whatever reason we can’t find your plan information, save your receipts and contact your plan directly to get refunds for any out-of-pocket costs you may incur.

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