Know Your Situation Before You Enroll

prescription drug plans

Medicare Part D (Prescription Drug Plans) are very different, and the way in which they fit with your Medicare Plan depends on your current coverage. This is also true if you currently have coverage through Medicaid Programs or Medicare Supplement Insurance. Your choices for Prescription Drug Coverage also depend on your current plan. Choose the link that fits your current health insurance coverage situation.

I have only Part A and/or Part B (the Original Medicare Plan) and no drug coverage

  • To have Medicare help pay for your prescription drugs, you must join a Part D plan.
  • Even if you do not use a lot of prescription drugs now, joining during the initial enrollment period will ensure that you avoid any penalty at a later time when you have more prescriptions.
  • Your Original Medicare plan service continues unchanged.

I have Medicare, and a Medigap (Medicare Supplement Insurance) policy with prescription drug coverage.

Your Medigap insurer must send you a detailed notice each year describing your choices for prescription drug coverage, and whether the drug coverage under your Medigap policy is creditable coverage. You have the following choices:

  • You can keep your current Medigap policy with the prescription drug coverage included.
  • You can join a Medicare Prescription Drug Plan and keep your current Medigap policy without the prescription drug coverage.
  • You can join a Medicare Advantage Plan that includes prescription drug coverage. All your health care benefits and prescription drug coverage will be covered by the same plan.
  • You should contact your Medigap insurance company before you make any changes.

I have Medicare, and a Medigap (Medicare Supplement Insurance) policy without prescription drug coverage

You can join a Medicare drug plan to help with the costs of your prescription drugs. You have the following choices:

  • You can keep your current Medigap policy and enroll in a stand-alone Medicare Prescription Drug (Part D) Plan for prescription drug coverage.
  • You can join a Medicare Advantage Plan that includes prescription drug coverage. All your health care benefits and prescription drug coverage will be covered by the same plan. However, if you join a Medicare Advantage Plan, your Medigap policy won’t pay any deductibles, copayments, or other cost sharing. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan.
  • You should contact your Medigap insurance before making any changes.

I have a prescription drug plan through an employer or union

  • If you have a prescription drug plan through a current or former employer or union (yours or your spouse’s) then you can keep it if it is creditable coverage. You will be informed yearly to let you know your coverage is creditable. If your employer or union stops offering coverage, you must join a plan within 63 days. If you wait longer than 63 days, then you will have to pay a penalty.
  • If you do not have creditable coverage, then you must join a plan during the initial enrollment period. If you do not join during this enrollment period, then you may have to pay a penalty.

I have prescription drug coverage through TRICARE, Veteran’s Affairs, or Federal Employee Health Benefits

Most of these plans pay for prescription drugs. It may be to your advantage to keep this coverage, and then you will not have to enroll in a separate Part D plan.

  • You should get information each year from your TRICARE, Veteran’s Affairs, or Federal Employee Health Benefits provider about your coverage and whether it is creditable coverage.
  • As long as you still qualify, your TRICARE, Veteran’s Affairs, or Federal Employee Health Benefits prescription drug coverage will not change.
  • If your TRICARE, Veteran’s Affairs, or Federal Employee Health Benefits stops offering coverage, you must join a plan within 63 days. If you wait longer than 63 days, then you will have to pay a penalty.
  • Contact your current plan before making any changes.

I have a Medicare Advantage Plan with prescription drug coverage

  • You should receive a notice each year about your prescription drug coverage.
  • Read all the materials carefully to understand your options.
  • You can get all your health care needs, including some prescription drug coverage through your Medicare Advantage Plan.

I have a Medicare Advantage Plan without drug coverage

You have the following choices:

  • Check with your current Medicare Advantage Plan to see if it offers a Medicare prescription drug option. If so, you can switch to that option.
  • If your current plan doesn’t offer Medicare prescription drug coverage, you can switch to another Medicare Advantage Plan.
  • If your current plan doesn’t offer Medicare prescription drug coverage, you can switch to Original Medicare and join a Medicare Prescription Drug Plan.
  • If your current plan doesn’t offer Medicare prescription drug coverage, you can join a separate, stand-alone Medicare Prescription Drug Plan for prescription drug coverage.
  • If you stay in your current plan that isn’t offering drug coverage and you don’t join a Medicare Prescription Drug Plan during the enrollment period, you may have to pay a penalty if you decide to enroll later.
  • Contact your current plan before making any changes.

I have prescription drug coverage through my state Medicaid programs

Medicare helps pay for your prescription drugs instead of Medicaid. If you didn’t select a plan, Medicare automatically enrolls you in a Part D plan to ensure that you have coverage.

  • If you decide to switch to a different Medicare drug plan, you can only change during annual enrollment.
  • Because you have Medicaid, Medicare automatically gives you Extra Help with your Medicare drug plan costs. If you haven’t yet joined a Medicare drug plan, Medicare enrolls you in a drug plan to make sure that you have drug coverage. Check to see if the plan covers the drugs you use and if you can go to the pharmacies you want. If you decide to switch to a different Medicare drug plan, you can do so at any time.
  • In limited cases, some state Medicaid programs may pay for prescriptions not covered by Medicare. If you continue to be eligible for Medicaid, Medicaid will still cover the other health care costs that Medicare doesn’t cover.
  • Contact your Medicaid plan for more information.

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