Understanding Medicare Part D

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A Comprehensive Guide to Medicare Part D

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While Original Medicare’s Parts A and B help cover the majority of costs related to hospital and medical care, for many people, there’s another potentially steep cost that isn’t covered: prescription drugs. That’s where Medicare Part D can help.

This is a voluntary prescription drug coverage that is an option for anyone who is enrolled in Medicare Part A and/or Part B, and it can prevent large out-of-pocket bills for those who rely on prescription medications for their health.
But it’s important to understand exactly how Medicare Part D can help, and how it connects with Medicare Advantage, or Medicare Part C, plans that replace Original Medicare’s Parts A and B.

Why You Should Consider Medicare Part D

If you regularly take prescription drugs, you should consider enrolling in a Medicare Part D plan. This voluntary drug coverage is offered by private insurance companies and approved by Medicare. Part D plans help cover your prescription drug costs, and as long as you are enrolled in Medicare Part A and/or Part B, you should be eligible.
It’s no secret that prescription drug costs are a major driver of healthcare-related spending in America, and that’s why it’s important to not overlook this important factor when considering all of your best options for health insurance and Medicare coverage.
Another thing to know is that enrolling in a Medicare Advantage Plan (Part C) with drug coverage is one more option to achieve this coverage and add to your covered benefits for healthcare-related expenses.

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Costs and Coverage of Medicare Part D

All Part D plans must cover certain drugs, but the specific drugs covered vary from plan to plan, and each plan has a list of covered drugs, called a formulary. Before enrolling, be sure to review to understand if your drugs are covered and at what level.

There’s a lot to consider, and a lot of research that needs to happen to make sure you’re choosing the best Part D plan for your personal needs. Luckily, you don’t have to navigate these complicated decisions alone.

Calling the Health Plus Life team is a great way to get started because our agents are experts who understand the options you have with the experience necessary to help you make the best decisions. We’re here to help, and we’re ready to work with you to help you find the best Medicare Advantage plan for you from a trusted carrier with one monthly premium (besides your Part B premium.)

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The Enrollment Process for Medicare Part D

Don’t be overwhelmed: understanding Part D enrollment is easier than you probably imagine.

There are three periods of time that are important to know when considering Medicare Part D:

  • Initial Enrollment Period (IEP): This is your first chance to enroll in Medicare Part D. This seven-month window of time starts three months before the month you turn 65 and ends three months after the month you turn 65.
  • Annual Election Period (AEP): If you didn’t sign up during the Initial Enrollment Period, you can do so later during the AEP from October 15 to December 7 each year Medicare beneficiaries can enroll in, change, or drop a Medicare Part D plan.
  • Special Enrollment Period (SEP): This isn’t available for everyone, but in certain situations, you might qualify for a SEP that gives you a window of time to sign up for Medicare Part D. Some common qualifiers for the SEP include a move, the loss of current coverage, a change in Medicaid eligibility, or another specific life event.

Now that you know when you can enroll, you’re probably wondering how to enroll in Medicare Part D. Again, you have options here. One option is to give our Health Plus Life team a call  as Health Plus Life can enroll you in a Medicare Advantage plan from a trusted carrier with one monthly premium (besides your Part B premium)

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Frequently Asked Questions About Medicare Part D

What is Medicare Part D?

Medicare Part D refers to the section of Medicare that provides prescription drug coverage. It’s specifically designed to help beneficiaries handle the often substantial costs of prescription medications, enabling them to access the treatments they require without incurring unmanageable expenses. Everyone with Medicare, regardless of income, health status, or prescription drug usage, has access to prescription drug coverage via Medicare Part D.

How does Medicare Part D work with Medicare Advantage plans?

Many Medicare Advantage plans, which are also known as Medicare Part C, incorporate prescription drug coverage similar to that of Medicare Part D within their coverage. If your Medicare Advantage plan includes drug coverage, it essentially becomes your “one-stop-shop” for all your Medicare services, including drug coverage. This means that you would obtain your prescription drug coverage directly through your Medicare Advantage plan, negating the need for a separate Part D plan.

Can I get a standalone Medicare Part D plan if I have a Medicare Advantage plan?

As a general rule, if you’re enrolled in a Medicare Advantage plan that already includes drug coverage, you can’t simultaneously be enrolled in a standalone Medicare Part D plan. Should you choose to enroll in a separate Medicare Part D plan while covered by a Medicare Advantage plan with drug coverage, you’d be automatically disenrolled from your Medicare Advantage plan and reverted back to Original Medicare. This could result in a loss of additional benefits provided by your Medicare Advantage plan, so it’s crucial to consider your options carefully.

What if my Medicare Advantage plan doesn’t offer drug coverage?

If you find yourself in a Medicare Advantage plan that doesn’t include prescription drug coverage, you’re not left without options for medication coverage. In this situation, you are permitted to enroll in a standalone Medicare Part D plan to ensure coverage for your prescription medications. It’s essential to confirm whether a potential Medicare Advantage plan includes drug coverage before enrollment to avoid any gaps in prescription coverage.

How much does Medicare Part D cost with a Medicare Advantage plan?

The costs associated with Medicare Part D as part of a Medicare Advantage plan can vary depending on the specifics of each plan. Typically, if your Medicare Advantage plan includes prescription drug coverage, the cost of this drug coverage will be integrated into the overall monthly premium for the Medicare Advantage plan. However, the specific costs will depend on factors like the plan’s premium, deductible, and copayments or coinsurance for medications, so it’s important to review all potential costs when considering a plan.

What drugs are covered under Medicare Part D in a Medicare Advantage plan?

Each Medicare Advantage plan that includes prescription drug coverage maintains its own formulary, which is a list that details all the prescription drugs covered by the plan. While these formularies can differ from one plan to the next, Medicare requires that they must each cover a wide range of drugs across most prescription categories, ensuring beneficiaries have access to the medications they need. However, the specific drugs covered and the associated costs can vary, so it’s important to review the formulary of any potential plan to ensure it helps cover your specific medications.

Can I change my Medicare Part D coverage if I have a Medicare Advantage plan?

Yes, only beneficiaries with Medicare Advantage plans and integrated Rx coverage can only change the entire plan and not just the Rx portion of the plan.

Where can I find more information about Medicare Part D in relation to Medicare Advantage plans?

The official Medicare website, www.medicare.gov, serves as a reliable resource for information about Medicare and the various Medicare parts. Another helpful option is to reach out to an expert team, such as the people at Health Plus Life. Health Plus Life can enroll you in a Medicare Advantage plan from a trusted carrier with one monthly premium (besides your Part B premium). Give the Health Plus Life team a call at 888-828-5064 and get started today.