Medicare Part D

As we advance in age, prescription drugs become somewhat a fixture in our lives, and simple health insurance is not enough to cover all our health costs. Medicare Part D can help with this. It is an optional healthcare benefit that offers coverage for prescription drugs. It is also known as a Prescription Drug Plan (PDP) and is available to everyone who has Original Medicare — that is, Medicare Part A and B.

To obtain it, you have to join a Medicare plan that also offers prescription drug coverage. Medicare Part D plans cover the cost of prescription drugs but do not offer medical coverage.

In California, there are thirty-two Medicare Part D plans offered by twelve different private health insurance companies that have a contract with Medicare. The cost of each plan and what it covers varies from company to company. The lowest premium per month in 2020 is $12.80 while the highest per month is $118.40.

How Does One Enroll For Medicare Part D?

To qualify for Medicare Part D, you have to sign up for Medicare Part A/or B and live in the area of the Part D plan you want to choose. If you already have Medicare Part A and/ or B, you can sign up for a separate Part D plan which will work together with your Part A and B. First, speak to an advisor who can help you find a plan that best suits you, and work with them to fill out an enrollment form. Your agent will need to give the exact date your Part A and B coverage began, and your Medicare number.

When Can I Enroll?

When you first become eligible for Medicare, you can enroll during the Initial Enrollment Period. This is the 7 month period that begins three months before your 65th birthday, includes your birthday month, and ends 3 months after your birthday month. If you fail to sign up for Part D when you first become eligible, you will have to pay a penalty for late enrollment when you do sign up. This penalty will apply for as long as you have Medicare Part D. You may, however, be exempted from paying a late-enrollment penalty if:

• If you have other creditable coverage for prescription drugs. This is cover that pays at least as much as the expected coverage paid by Medicare. If you already have this cover when you qualify for Medicare, you can keep it, and you won’t pay a penalty if you decide to sign up for Part D later on.
• If you get Extra Help- This is a Medicare program that helps people pay for Part D costs like premiums and deductibles if they have limited resources. In 2020, if you make $19,140 yearly in income (for married couples- $25,860), and have resources amounting to $14, 610 (for married couples-$29,160), you may be eligible for Extra Help.

You can also sign up during the Annual Election Period that begins on October 15th and ends on December 11th every year. It’s also known as the Open Enrollment Period for Medicare Advantage and Medicare Part D coverage. If you decide to opt-out of Medicare Advantage, you can do so during the Medicare Advantage Open Enrollment Period that runs from January 1st to March 31st. This will revert you back to Original Medicare, after which you can sign up for a stand-alone Part D Plan.

Current Health Coverage and Medicare Part D

Before you pick a prescription drug plan, consider how it might affect any other drug coverage you have. This is because having Part D could change your current coverage. Keep in mind also that if you already have a Medicare Advantage Plan (Part C), you automatically lose it by enrolling in Medicare Part D.

When you sign up for a stand-alone Medicare Part D plan, you automatically lose your current health cover unless you have any of these:

• A Cost Plan
• Medical Savings Account plan
• Private Fee- for Service (PFFS) Plan
• Medicare health plans sponsored by your employer (in some cases).

So make sure you talk to an advisor, as as those here at the California Heath Agency who can help you understand how getting Part D will affect your coverage.

Frequently Asked Questions

What if I don’t qualify for Extra Help but I still can’t meet my prescription drug costs?

Contact us, because there are still things that can be done in this situation and we can still help you.

What if my circumstances change and I need Extra Help?

If you didn’t qualify for extra help before but your income and resources decrease, we can help you reapply for it.

What counts as resources when considering Extra Help?

Stocks, bonds, and money in a savings or checking account are considered as countable resources, while a home, one car, a burial plot, household items, personal items, and up to $1500 in burial expenses set aside are not counted as resources.

Can I Change my Part D plan?

Yes, you can change your plan for whatever reason. Simply call us at any time, inform us of the plan you’d like to change to, and we will help you change plans.

What is meant by a ‘formulary’?

This is the list of prescription drugs covered under prescription drug plans. Most Part D plans have their specific lists of drugs they cover. At least two drugs in the most frequently prescribed groupings are included in the formulary to enable people with different conditions to access the drugs they need.

Can I get generic drugs with Medicare Part D?

Yes, you can. Part D formularies contain both generic and brand-name drugs.

What if I can’t find a specific drug in the formulary?

Most of the time, an alternative drug is available. If, however, none of the available drugs is suitable for your condition, and your healthcare provider concurs, you can ask for an exception.

Do the drugs in the formulary change?

Yes, drugs can change. A Medicare plan can change the drugs in its list provided they follow Medicare guidelines. For support or more information, contact us and we’d be more than happy to assist you.