Prescription drug coverage is available to everyone with Medicare. Plans vary in cost and drugs covered. For more information, read the FAQs below or contact us to talk to a certified counselor.
Who is eligible?
Individuals who are enrolled in Medicare Part A or Medicare Part B regardless of income, are eligible for Medicare Part D.
What happens if I do not enroll?
If you do not have other “creditable” drug coverage and you decide not to enroll in a Part D Plan, you may be charged a late enrollment penalty. This penalty would be 1% of the national base premium amount for every month you were not enrolled from the time you first became eligible. Also, you can only enroll during open enrollment (October 15- December 7) and your coverage will start January 1 of the following year. If you are eligible for the “Extra Help” subsidy, you will not have a penalty and you may enroll at any time.
When is enrollment?
Every year, open enrollment begins October 15 and lasts through December 7.
How do I enroll?
If you are new to Medicare, you have an initial 7 month enrollment period, which includes the 3 months prior to your eligibility, the month you become eligible, and the 3 months after you are eligible. We encourage you to use the online Plan Finder to find the Part D plan that is best for you. We strongly suggest that you use the Plan Finder each year during the enrollment period. Plans change coverage and costs every year.
Medicare will auto-enroll dual eligibles (those with Medicare and full Medicaid) in a Part D plan. When you find out which plan you were enrolled in, call to find out if all your prescriptions are covered. Call a VICAP counselor if you have concerns. VICAP staff can help you review your options.
Am I eligible for financial assistance if I do not have Medicaid?
If your current annual income is below 150% of the Federal Poverty Level and you have limited assets, you may also be eligible for a subsidy (“Extra Help”) for Part D. If you believe you are eligible for financial assistance, call 703-228-1700 and ask to speak to a VICAP Medicare Counselor. You may also apply at your local Social Security office or online at www.socialsecurity.gov.
Am I eligible for Part D financial assistance if I have Medicaid?
If you have Medicare and full Medicaid (“dual eligible”), you will be enrolled in a Part D Plan with a full subsidy. If you have Medicare and a Medicare Savings Program (MSP) such as QMB, SLMB or QI, but not full Medicaid, you will be eligible for some subsidy and will be enrolled in a plan.
What if I have retiree health insurance?
Your company will notify you by October each year, whether the policy’s drug benefit is “creditable.” Creditable means that the coverage is as good as or better than the Medicare Prescription Drug Benefit for the upcoming year. If you have creditable coverage, you will not need to enroll in Medicare Part D.
What if I have Tricare, VA benefits, or a Medigap policy?
Tricare For Life, VA benefits, and federal government benefits are all creditable, which means they are as good as or better than Medicare Part D coverage. Old Medigap plans with prescription drug coverage are not creditable.
Will I need Part D if I am in a Medicare HMO?
Possibly. The Medicare HMO will have to inform their members as to whether or not the drug benefit that is part of the HMO is creditable.
How much will Part D cost?
For basic benefits, there may be a deductible and a monthly premium. You also have co-payments for medication until the total retail cost paid by you and the plan together reaches a dollar limit set by Medicare every year.
Part D plans vary greatly in what they cost, how much they cover, and which drugs they cover. It is very important to study all the details before you choose a plan. For example, some plans have no deductible and some plans will cover some drugs in the “donut hole” and some plans may not charge you for generic drugs.
Will the drugs I need be covered under Part D?
Each plan will have a formulary of prescription drugs covered. Special exceptions will be made in some circumstances. You may have to appeal to the plan to make an exception.
How will I find out what plans are being offered and what drugs are covered?
Plans will be announced by September each year. If you are enrolled in plan, you will receive your plan’s Annual Notice of Change in September. It is very important to read this document.