How do Medicare Prescription Drug Plans function, and what are they?
Everyone with Medicare has access to prescription drug coverage. If you don’t enroll in Medicare Prescription Drug coverage (Part D) when you first become eligible and don’t have any creditable prescription drug coverage or Extra Help, you’ll almost certainly be charged a late enrollment penalty.
You must enroll in a Medicare drug plan offered by an insurance company or another private company that has been approved by Medicare. The cost and medications covered by each plan may differ.
There are two options for obtaining drug coverage:
1. A Medicare Prescription Drug Plan, for starters (Part D)
2. A Medicare Advantage Plan (Part C), such as an HMO or PPO, or any other Medicare health plan that covers prescription drugs.
For additional information on these two alternatives, go to Medicare.gov or contact 1-800-MEDICARE (1-800-633-4227). For TTY users, dial 1-877-486-2048.
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Who is eligible for Prescription Drug Plans under Medicare?
- You can join up for these policies or make modifications to your existing coverage at particular times. In general, you can join, switch, or drop a Medicare drug plan in the following ways: When you first become eligible for Medicare as a result of reaching or exceeding the age of 65. During your Initial Enrollment Period, which begins three months before the month you age 65, includes the month you turn 65, and ends three months after the month you turn 65, you can enroll in a Medicare drug plan. In most situations, if you enroll during the first three months of your Initial Enrollment Period, your coverage will begin on the first day of your birthday month. If your birthday falls on the first of the month, however, your coverage will begin on the first of the previous month. The start date for your coverage will be delayed if you enroll the month you turn 65 or during the last three months of your Initial Enrollment Period.
- You can join a Medicare drug plan from April 1 through June 30 if you acquire Part B for the first time during the General Enrollment Period. Your protection will begin on July 1st.
- Each year, between October 15 and December 7, during open enrollment. If you request coverage during Open Enrollment, your coverage will begin on January 1 of the following year.
- If you qualify for Extra Help at any time. Extra Help is a Medicare program that assists persons with limited income and resources with paying premiums, deductibles, and coinsurance for Medicare prescription medication plans.
- When specific life circumstances occur, such as moving or losing other insurance coverage. Special Enrollment Periods (SEPs) are opportunities to make adjustments (SEPs). Each SEP has its own set of rules for when you can make changes and what kinds of changes you can make.
There are two options for obtaining Medicare drug coverage:
Plans for prescription drugs under Medicare. Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service Plans, and Medical Savings Account programs all provide prescription coverage under these plans. You should have
To join a separate Medicare medication plan, you must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance). 2.
Drug coverage is available through a Medicare Advantage Plan (Part C) or another Medicare Health Plan. These plans cover all of your Part A, Part B, and medication coverage. To join a Medicare Advantage Plan, you must have both Parts A and B, and not all of these plans include prescription drugs. You must be a US citizen or lawfully present in the US to join a Medicare drug plan, Medicare Advantage Plan, or other Medicare health plan with drug coverage.
To acquire particular Medicare prescription plans and Medicare Advantage Plan costs, go to Medicare.gov/plan-compare and call the plans you’re interested in for more information. Contact your State Health Insurance Assistance Program for assistance in comparing plan costs (SHIP).
Find a Medicare medication plan that fits your needs.
When it comes to Medicare prescription coverage, there are six things to keep in mind.
How to Enroll in a Prescription Drug Plan
Here's how to acquire prescription drug coverage after you've chosen a Medicare drug plan:
- Enroll in a Medicare plan using the Medicare Plan Finder or the plan’s website.
- Fill out an enrollment form on paper.
- Make a plan.
- Please contact us at 1-800-MEDICARE (1-800-633-4227). 1-877-486-2048 (TTY).
When you sign up for a Medicare drug plan, you’ll need to provide your Medicare number as well as the start date of your Part A and/or Part B coverage. Your Medicare card has this information.
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Think about all of your drug coverage options.
Learn how prescription drug coverage interacts with your other drug coverage before making a decision. You may have prescription coverage through a job or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or Medicare Supplement Insurance (Medigap) insurance, for example. Compare your current drug coverage to that provided by Medicare. Because your current drug coverage may change as a result of Medicare drug coverage, think about all of your possibilities.
Read all of the papers you receive from your insurer or plan provider if you have (or are eligible for) other types of drug coverage. Before making any changes to your current coverage, speak with your benefits administrator, insurer, or plan provider.
Your Medicare Advantage Plan may be affected if you join a Medicare medication plan.
If you join a Medicare Advantage Plan, you’ll almost always be covered for prescription drugs. You can join a separate Medicare drug plan if your Medicare plan can’t offer drug coverage (like Medical Savings Account plans) or chooses not to offer medication coverage (like certain Private Fee-for-Service plans). If you join a different medication plan while participating in a Health Maintenance Organization, HMO Point-of-Service plan, or Preferred Provider Organization, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
Only if you're in one of the following situations can you join a separate Medicare medication plan without losing your current health coverage:
- Plan for a Private Fee-for-Service
- Plan for Medical Savings
- Budgeting
- Certain Medicare health insurance are provided by employers.
If you have any questions about what will happen to your current health coverage, contact your current plan.
CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Aid Plan Comparisons for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) announced the 2022 Star Ratings for Medicare Advantage (Medicare Part C) and Medicare Part D prescription medication plans today to assist Medicare beneficiaries in comparing plans ahead of Medicare Open Enrollment, which begins on October 15. Plans are scored on a scale of one to five stars, with one star indicating bad performance and five stars indicating good performance. The Star Ratings are published once a year and represent the experiences of Medicare Advantage and Part D prescription medication plan members. CMS’s efforts to empower consumers to make the greatest healthcare decisions are aided by the Star Rating system.
“CMS Administrator Chiquita Brooks-LaSure remarked, “The Medicare Advantage and Part D Star Ratings are vital tools in the toolbox for beneficiaries to employ as they assess Medicare coverage options.” “The CMS’s yearly ratings provide useful information about the quality of each plan, allowing Medicare beneficiaries to make well-informed health-care decisions.”
Medicare beneficiaries can use the online Medicare Plan Finder tool on Medicare.gov to compare quality using the Star Ratings, as well as other information such as cost and coverage. According to the most recent data, roughly 68 percent of Medicare Advantage plans that cover prescription drugs will have a four-star rating or better in 2022, up from 49 percent in 2021. In 2022, nearly 90% of persons enrolled in Medicare Advantage plans that include prescription medication coverage will be in a plan with four or more stars. The number of proposals with a four-star grade or higher is up for 2022 compared to the previous year. While modifications for the 2022 Star Ratings were made because to the potential impact of the COVID-19 pandemic, this also represents gains in sponsors’ scores on key metrics.
Open Enrollment for Medicare begins on October 15, 2021, and finishes on December 7, 2021. Medicare beneficiaries can examine coverage alternatives such as Original Medicare and Medicare Advantage, as well as health and medication plans for 2022, during this period. Costs and included benefits of Medicare Advantage and Part D plans might change from year to year, so Medicare beneficiaries should review their coverage options and choose the ones that best match their health needs. They can get more information by going to Medicare.gov (https://www.medicare.gov), calling 1-800-MEDICARE, or contacting their State Health Insurance Assistance Program.
