Medicare Part D (PDP) Insurance Plans
Medicare offers Medicare Part D plans to everyone with Medicare. It began in January 2005, and by most accounts has been advantageous for seniors. To get a Medicare Part D plan, you must join a plan run by an insurance company or other private carrier approved by Medicare. Each plan can vary in cost and drugs covered.
Most Medicare Advantage plans have a prescription benefit built in the plan. However, Medicare Supplemental Insurance Plans do not include a Medicare Part D Plan. In order to obtain prescription coverage you would have to apply separately for a Medicare Part D plan.
Most Medicare Part D Plans are divided in 4 tiers. It begins with Tier 1, the lowest and most inexpensive tier which includes generic drugs. The highest tier is Tier 4, the most expensive tier consisting of the more costly drugs or brand name prescriptions. Some least expensive Medicare Part D plans may have a deductible that must be met for brand name drugs. For instance, if your Medicare Part D plan has a $150 brand name deductible, you must meet the deductible first before benefits begin.
How to find a Medicare Part D Plan
- Make certain you meet the enrollment guidelines. For instance, open enrollment starts October 15, 2015 – December 7, 2015 (which means you can drop or add any plan during this period), just turning 65 or new to Medicare, and if you have currently lost coverage with an employer group plan.
- Make sure you are enrolled in Part A or Part B. If you are not enrolled with a Medicare program, you will not be able to obtain a Medicare Part D Plan.
- Have a list of your medications on hand so you can see what your cost will be with your new Medicare Part D plan.
- Call a licensed agent to shop around the most comprehensive and affordable Medicare Part D Plan.
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What Special Circumstances Warrant Part D Coverage Changes?
As a Medicare Part D recipient, you are able to make changes to your insurance coverage only during certain times of the year. These “enrollment periods” take place within about seven months of your sixty-fifth birthday, and then again at the end of each year. Generally, they are scheduled between late October and the first few days of December. The genius of the Medicare program is that it is structured so that it can easily enroll the thousands of people who may become eligible for benefits each and every year. Of course, it can also prove inconvenient in some circumstances.
Luckily, there are certain specific events that can trigger a special enrollment period just for you. Naturally, these have been planned out so that they are very uncommon — no one can abuse them in order to change their Medicare Part D coverage. But since life does change and any of these events could happen to you, it’s important to know what is available. When any of these events take place, you will have the opportunity to add, drop, or change Medicare coverage to suit your needs. Not surprisingly, many of them relate to moving to a new area with different medical resources.
A special enrollment period will be triggered in regards to your Medicare Part D coverage if you move to a new address that isn’t in your plan’s service area. Depending upon your plan, this could mean anything from moving down the street to moving to a new city or state. Generally, you will always enter into a special enrollment period if you move to another state, however. Likewise, if you move to a new location that is still within your plan’s servicing area, but also offers additional service options, you will have the chance to choose these insurance options instead.
There are also a few unusual options which can apply not only to Medicare Part D, but also to several other areas of Medicare. If you move to the United States after living abroad and are eligible for Medicare coverage, you will enter into a special enrollment period on the day you reach the United States. You’ll also start a new enrollment period on the first day you are released from an institution, such as an assisted living or care facility, and the day you are released from jail. These options help you to manage your insurance after major life events and changes.