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Medicare Prescription Drug Coverage

People with limited income and resources who don't have Medicaid, may qualify for extra help that may pay for about 95% of their drug costs. Visit Extra Help For People with Limited Income and Resources for more information.

Because the way that Medicare drug coverage works depends on a person's current coverage, Medicare has specific information available to help everyone, regardless of their coverage. These resources include the CMS brochure What Medicare Prescription Drug Coverage Means to You: A Guide to Getting Started and the Medicare & You Handbook mailed to all people with Medicare this fall. The brochure and other free Medicare publications are available by visiting www.medicare.gov or calling 1-800-MEDICARE. People with Medicare should also look for and review information from their current insurer about how their current coverage will work with the Medicare prescription drug coverage.

To find out how much someone with Medicare can save with Medicare prescription drug coverage, visit the Medicare Prescription Drug Plan Cost Estimator at www.medicare.gov . This information is also available by calling 1-800-MEDICARE (1-800-633-4227) / TTY: 1-877-486-2048.

Determining what matters most and reviewing plan options

Once someone decides that they want prescription drug coverage, they should think about what matters most to them. There are a range of plan options available, so they can focus on the kind of coverage they prefer. There are two ways to get Medicare drug coverage. They can add drug coverage to the traditional Medicare plan through a 'stand alone' prescription drug plan. Or they can get drug coverage and the rest of their Medicare coverage through a Medicare Advantage plan. No matter what type of plan they choose, they can choose a plan that reflects what they want in terms of cost, coverage and convenience.

  • Cost: What a person with Medicare pays for the coverage, including premiums, deductible, and payments for drugs.
  • Coverage: What benefits are provided (like coverage in the 'coverage gap' and other coverage enhancements), which drugs are covered and the rules (like prior authorization) for getting those drugs.
  • Convenience: Which pharmacies are part of the plan and whether the plan has a mail-order option.

Choosing a plan

There are many ways to choose a plan. Some may rely on advice from people they know or trust, or choose a plan they are already familiar with, or use the Landscape of Local Plans located on www.medicare.gov to find a plan that meets their needs. All of the plan options must meet or exceed Medicare's standards for coverage, including coverage for medically necessary drugs.

We are happy to assist CDA Insurance’s Medicare Supplement clients with selecting Part D prescription plans. As an Agency we do not receive commissions from many of the Part D carriers. Because of this, the amount of time it takes to run proposals and explain them appropriately, unless CDA Insurance is the agent for your Medicare Supplement plan, we are unable to provide this service to you.

If you are our client, or we are assisting you with your new Medicare Supplement plan, we ask that you supply us with the following information via e-mail when it is time to run the proposal:

  • Prescription name, dosage, quantity for 30 day supply
  • The names of two preferred pharmacies where you live (include your zip code)
  • Let us know if you would prefer to use mail order instead of a local pharmacy

This is best done by email so we can get correct spellings and dosages on all medications.
Please submit the above list to our email address.
If you are not a client of CDA Insurance, or wish to run the quotes yourself, here is the link to the Medicare quoter: https://www.medicare.gov/find-a-plan/questions/home.aspx

If people want to make more specific plan comparisons based on what matters to them, they can get personalized information from the Medicare Prescription Drug Plan Finder . The Medicare Prescription Drug Plan Finder can be accessed at www.medicare.gov or through a customer service representative at 1-800-MEDICARE (1-800-633-4227) / TTY: 1-877-486-2048, or through the many organizations working with Medicare to help people take advantage of the new drug coverage.

Enroll

  1. You can join when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.
  2. If you didn't join when you were first eligible, you can join between October 15th to December 7th of each year. Your coverage will begin on January 1 of the following year. Generally, your next opportunity to make a change will be between October 15th to December 7th of each year.
  3. Late Enrollment Penalty (LEP) If you don't join a Medicare prescription drug plan when you're first eligible, you must wait until your next enrollment opportunity to join a drug plan, and you may have to pay a higher premium because of a late enrollment penalty.
  4. If you are assessed a late enrollment penalty:
    1. The amount will be billed or deducted with your drug plan premium.
    2. You will be charged a penalty for as long as you continue to have Medicare prescription drug coverage.
    3. It will change on an annual basis.

Note: In certain situations, you may be able to join a Medicare Advantage plan or Medicare Prescription Drug Plan at other times. For example, if you:

  • Move out of your plan's service area
  • Have both Medicare and Medicaid
  • Live in, or move into or out of an institution (such as a nursing home)
  • Have creditable prescription drug coverage and that coverage ends
  • Lost employer coverage or your plan coverage is no longer available in your area

WHAT IS CREDITABLE COVERAGE?

Medicare beneficiaries will have the opportunity to receive subsidized prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to sign up at the first opportunity may have to pay more if they wait to enter the program later after the open enrollment period. [more information]

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