Medicare drug coverage helps pay for prescription drugs you need. It's optional and offered to everyone with Medicare. Even if you don’t take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.
There are 2 ways to get Medicare drug coverage:
1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee‑for‑Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan.
2. Medicare Advantage Plan (Part C) or other Medicare Health Plan with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.
To join a Medicare drug plan, Medicare Advantage Plan, or other Medicare health plan with drug coverage, you must be a United States citizen or lawfully present in the United States.
Consider all your drug coverage choices.
Before you make a decision, learn how prescription drug coverage works with your other drug coverage. For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy. Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options.
If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.
As of January 1st, 2023, the cost of a one-month supply of each Part D-covered insulin is capped at $35 and you don't have to pay a deductible. If you get a 60- or 90-day supply of insulin, your costs can’t be more than $35 for each month’s supply of each covered insulin.
Please reach out to Georgette Reed if you cannot find an answer to your question.
You can sign up for a plan during annual enrollment which is October 15 to December 7th. The plan will not start until January 1st the following year. But you will be charged a penalty for not having a drug plan from your initial enrollment period. Also, it is highly recommended that you have some plan other than straight Medicare A and B. Medicare Advantage Plans that include drug coverage are a great way to add coverage for little to no cost. Yet, you will still be assessed a penalty.
The penalty rate changes year to year, but it is about $5 a year for every year you should have had a plan. It is based on the months missed. This will be added as a monthly charge by Medicare to your plan cost. If your Medicare Advantage plan costs you nothing, and you have waited two years to sign up for a plan, you will have to pay approximately $10 a month for your plan now. The penalty never goes away, so it is important that you think of future issues that could happen for prescription costs.
Unfortunately, there is no way to get out of the penalty if you did not have drug coverage from another source when you were eligible for Medicare. Individuals who have Veteran or Native American healthcare can receive an exception. So, make sure Medicare is aware if you have access to these programs. One way I help individuals with a penalty is to find a plan that offers Medicare Part B pay back. If your plan pays back $75 a month and you have a penalty of $25, then you would still receive an extra $50 off your Medicare Part B. This plan will include drug coverage so the penalty will not continue to rise in cost but freeze at the plan’s start date.
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