Managing Your Drug Plan

2 Ways to Get Medicare Drug Coverage

There are two ways to get Medicare prescription drug coverage:

  • Medicare Prescription Drug Plans - These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  • Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage - You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs." You must have Part A and Part B to join a Medicare Advantage Plan.

Both types of plans are called "Medicare drug plans." In either case you must live in the service area of the Medicare drug plan you want to join.

When Can You Join a Medicare Drug Plan?

Between October 15 – December 7, anyone can join, switch, or drop a Medicare drug plan. The change will take effect on January 1 as long as the plan gets your request by December 7.

When you're first eligible for Medicare, you can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of disability, includes your 25th month of disability, and ends 3 months after your 25th month of disability. You'll have another chance to join that starts 3 months before the month you turn 65 ends 3 months after the month you turn 65.

Special Enrollment Periods

You generally must stay enrolled for the calendar year. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans at other times:

  • If you move out of your plan's service area
  • If you lose other creditable prescription drug coverage
  • If you live in an institution (like a nursing home)

How to Join a Medicare Drug Plan

Once you choose a Medicare drug plan, you may be able to join by:

  • Enrolling on the plan's Web site or on
  • Completing a paper application
  • Calling the plan
  • Calling 1-800-MEDICARE

When you join a Medicare drug plan, you'll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

Joining a Medicare Drug Plan May Affect Your Medicare Advantage Plan

If your Medicare Advantage Plan includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

How to Switch Your Medicare Drug Plan

You can switch to a new Medicare drug plan simply by joining another drug plan. You don't need to cancel your old Medicare drug plan or send them anything. Your old Medicare drug plan coverage will end when your new drug plan begins.

If you want to join a plan or switch plans, do so as soon as possible so you'll have your membership card when your coverage begins, and you can get your prescriptions filled without delay. You should get a letter from your new Medicare drug plan telling you when your coverage begins.

Don't give personal information to plans that call you unless you're already a member of the plan.

How to Drop Your Medicare Drug Plan

  • You can disenroll by calling 1-800-MEDICARE.
  • You can also send a letter to the plan to tell them you want to disenroll.

If you drop your plan and want to join another Medicare drug plan later, you have to wait for an enrollment period. You may have to pay a late enrollment penalty.

What You Pay for Medicare Drug Coverage

You'll make these payments throughout the year in a Medicare drug plan:

  • Monthly premium
  • Yearly deductible
  • Copayments or coinsurance
  • Costs in the coverage gap
  • Costs if you get Extra Help
  • Costs if you pay a Late Enrollment Penalty

Your actual drug plan costs will vary depending on:

  • The prescriptions you use and whether your plan covers them
  • The plan you choose
  • Copayments or coinsurance
  • Whether you go to a pharmacy in your plan's network
  • Whether your drugs are on your plan's formulary
  • Whether you get Extra Help paying your Part D costs

Look for specific Medicare drug plan costs, and then call the plans you're interested in to get more details.

If you have limited income and resources, see if you qualify for Extra Help to pay for Medicare prescription drug coverage. You may also be able to get help from your state.

Monthly Premium

Most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you belong to a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium you pay to your plan may include an amount for prescription drug coverage.

Get Your Premium Automatically Deducted

Contact your drug plan (not Social Security) if you want your premium deducted from your monthly Social Security payment. Your first deduction will usually take 3 months to start, and 3 months of premiums will likely be deducted at once.

After that, only one premium will be deducted each month. You may also see a delay in premiums being withheld if you switch plans. If you want to stop premium deductions and get billed directly, contact your drug plan.

Your Premium Could Be Higher Based on Income

A small group—fewer than 5% of all people with Medicare—may pay a higher monthly premium for Part D coverage based on their income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare 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 limit, you'll pay an extra amount in addition to your plan premium. Usually, the extra amount will be deducted from your Social Security check.

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