medicare part D

If you’re 65 or older, mark your calendar for Medicare Open Enrollment October 15 – December 7 this year. It is an important time of year to review your current medical coverage and healthcare needs, and select the most appropriate Medicare plan for the new year. Even if you’re already enrolled in Medicare, it’s still a good idea to review your plan, since coverage — and your health needs — may change from year to year. If you will become eligible for Medicare coverage for the first time in 2019, now is a good time to start learning about the different types of Medicare (e.g., Medicare Part A, Part B, Part C and Part D), and what this means for you.

The open enrollment period for Medicare 2019 begins on October 15, 2018, and ends on December 7, 2018. Here’s what you need to know about Medicare — especially Medicare Part D open enrollment.

What are the different types of Medicare?

Medicare is an insurance plan provided by the federal government and overseen by the Centers for Medicare and Medicaid Services (CMS). Medicare coverage is divided into four general sections, each of which covers different services. You must be enrolled in Parts A and B to be eligible for Part D.

• Medicare Part A covers hospital expenses (i.e., pays for costs if you are hospitalized or placed in a nursing home).
• Medicare Part B covers outpatient services such as doctor’s visits, labs, immunizations, X-rays and surgeries that don’t require you to stay overnight in a hospital.
• Medicare Part C — also known as Medicare Advantage — is a type of Medicare coverage offered by private insurance companies that contract with CMS. It is available to anyone who is enrolled in Medicare Parts A and B. Medicare Advantage plans cover not only the services provided by Parts A and B, but may also offer dental, vision and/or prescription drug coverage.
• Medicare Part D is a supplemental form of Medicare that specifically covers prescription drug services. If you are enrolled in Parts A and B, then you can enroll in a Part D plan for prescription coverage.

Why Medicare Part D?

Medicare Part A only covers medications that you receive while you are in a hospital or a skilled nursing facility. Medicare Part B only covers a limited number of medications — and typically only if they are administered in an outpatient setting (such as a doctor’s office or clinic). Examples include vaccines, injectable medications and medications given by IV.

This lack of regular prescription coverage can be a significant problem for older adults. According to a 2016 report published by the CDC, more than 90% of adults 65+ are taking at least one prescription drug each month — and more than 42% are taking five or more prescription drugs monthly. If you’re 65 or older, it’s worth looking into how signing up for Medicare Part D coverage may save you money — especially if you are already taking multiple prescriptions.

Who qualifies for Medicare Part D?

Anyone who is eligible for Medicare coverage is also eligible for Medicare Part D. In general, you will qualify for Medicare if you are 65 years of age or older. However, if you are under 65, you may also qualify under special circumstances — for example, if you’re disabled (and have been receiving disability checks from Social Security Disability Insurance for at least 24 months) or have end-stage renal disease.

More information on Medicare Special Needs Plans can be found here.

Where can you sign up for it?

Once you are enrolled in Medicare Parts A and B, you can sign up for Medicare Part D coverage on the Medicare Plan Finder page. You can review and select health plans after entering your zip code and answering a series of questions. If you are already enrolled in a Medicare Part D plan, your plan will automatically renew, so technically, you’ll only need to visit the website if you want to change plans. However, it’s still a good idea to review your plan every year in case your current plan has changed — or to see if a different plan would better fit your current needs.

Important to note:

A Medicare Advantage Plan or Part D can change its official list of medicines that may be prescribed each year. This means that a drug that was covered in 2018, may not be covered by the same company in 2019.

Medicare plans may also change their network of providers, change the way they cover a medical service, and/or drop additional benefits like dental, vision and hearing coverage.

How much does it cost?

The Medicare Plan Finder page will also give you pricing information. You will be prompted to type in your list of medications and select your preferred pharmacy. The website will then populate with a list of plans you can choose from. The cost of your Medicare Part D plan may vary based on the plan you select and where you live. You’ll want to compare plan costs and copays to determine which plan will work best for you.

Need help?

Please ask one of our pharmacists. We can help you work through which plan is right for you and help you with enrollment. We also have a computer program that will automatically populate your medications, so you don’t have to do it yourself. Get started sooner rather than later so you have plenty of time to determine which plan is right for you.