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How do you apply for Medicare Part D?

How do you apply for Medicare Part D?

Just the essentials...

  • Medicare Part D is the prescription drug portion of the federal Medicare program

  • To qualify for Part C or D, applicants must be enrolled in Medicare Part A or Parts A and B

  • Medicare beneficiaries can get prescription drug coverage in a stand-alone program

  • Beneficiaries can get prescription drug coverage through a combination Medicare Advantage policy under Part C

  • Beneficiaries can enroll during the annual open season October 15 through December 7

Medicare Part D is the valuable subsidy for prescription drugs provided by the Medicare laws. Private companies operate the plans. Medical insurance, hospital coverage, and prescription drug coverage are the three insurance concerns of Medicare.

Part D (Prescription Drug Coverage) is a vital part of medical care. Many patients require medicines and long-term courses of medication to manage their conditions.

Part D plans offer a wide range of coverage options, deductibles, and premiums. When selecting a Part D plan, consumers can benefit from comparison shopping using current medications.

Those that can anticipate additional future demands can include that information when comparing plans.

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Qualifying for Social Security Medicare

How do you apply for Medicare Part D?

Applicants for Medicare Part D must first qualify for Social Security medical and retirement benefits including Medicare. They can qualify on the basis of age, age plus disability, and disability.

  • Age 65.
  • Age 64 or less with a disability.
  • Age 65 with a disability.

Medicare Advantage Providers

How do you apply for Medicare Part D?

Private companies approved by the federal government offer Medicare Advantage plans.

These organizations offer health insurance and prescription drug insurance plans. The notation MA-PD describes plans that offer Medicare Advantage with drug insurance.

These companies take several forms including the below-listed managed care types.

  • HMO plans manage care through a primary care physician that must approve use of resources by referrals.
  • PPO plans permit patients to go outside of the network but must pay more than when using in-network resources.
  • EPO plans use small networks, and patients must stay in-network to get coverage.
  • POS plans use a primary care physician to control and direct patient care; it covers referrals by the PCP to outside resources.

Medicare Advantage Plans

How do you apply for Medicare Part D? - Medicare Advantage

Medicare Advantage plans may or may not have prescription benefits. Those that have prescription benefits serve the same function as a Medicare Part D Prescription Drug plan.

They provide insurance coverage for prescription medicine costs. They follow rules that help provide a clear understanding of these coverage benefits.

The Drug Tiers

How do you apply for Medicare Part D?

Pharmaceutical companies develop and manufacture a wide range of prescription drugs. The federal government ranks them in tiers based upon costs.

The tiers rank one through four or one through five. The lower tiers have low prices and have many generic drugs. The upper tiers have higher prices and fewer generic equivalents.

Prescription drugs prices are higher for brand names and specialty drugs.

Manufacturers charge high prices based on factors such develop and production costs.

The higher tier drugs cost more and get more limitations from the insurers. The insurers urge the use of effective lower cost generic drugs.

Freedom of Choice

How do you apply for Medicare Part D? - Medicare Diagram

The stand-alone drug plan in Part D gives the applicant more freedom to choose a plan than the combination coverage in Part C Medicare Advantage.

The applicant can choose the prescription drug plan in Part D; in the combination programs, the program administrator often has authority to designate the drug plan.

Authorized Sign-up Periods

There are limited periods of the year in which to apply for Medicare Part C and Medicare Part D Prescription Drug coverage.

  • Initial enrollment period
  • Annual open season
  • Medicare Advantage Disenrollment period
  • Special enrollment periods

Advantages of Initial Enrollment Period

The initial enrollment is the best time to sign up for every part of Medicare. It is the time to get insurance and prescription coverage without penalty and on the most economical terms.

Applicants that do not add Parts B, C, or D during the initial signup may face a penalty when adding them later.

No Dual Enrollment

How do you apply for Medicare Part D? - Medicare Enrollment Form

Medicare does not permit simultaneous enrollment in Part D stand-alone and a Part C Medicare Advantage with prescription drug coverage; it is sometimes called an MA-PD.

If an applicant enrolls in a Part D program while enrolled in a Medicare Advantage program with drug coverage, the CMS administration will cancel the Medicare Advantage membership and return the applicant to Original Medicare.

Extra Help

How do you apply for Medicare Part D?

The Extra Help program has income and asset limits. It is a limited Income subsidy, or LIS, or incomes up to 150 percent of poverty line.

Successful applicants cannot exceed the limit for cash and other financial assets.

The beneficiaries get low-income subsidy pricing on generic drugs and covered brand name drugs. This program works to reduce costs to LIS levels even when the subscriber enters the lower range of the “donut hole”.

Benefits of Prescription Drug Coverage

Prescription drug coverage reduces the costs of medicines. For patients with long-term prescriptions, this can amount to significant savings. Some prescription drug plans come with zero deductibles. Many more offer achievable deductibles in the range of $300 per year.

The 2020 deductible limit is $435. Once subscribers pass the deductible amount for the year, the insurance benefits start. The insurer pays the agreed coinsurance. Users that have tier one generics pay a nominal copay.

The Donut Hole

Part D plans contain a gap in coverage called the donut hole. The hole is a limit on drug plan payments.

In 2020 subscribers enter the donut hole at $4,020. In this range, subscribers pay a maximum of 45 percent of the drug price for brand name drugs.

The rules add the balance of fifty percent of the price to the 45 percent so that 95 percent counts as out-of-pocket expenses. These add up to get the subscriber out of the donut hole and pass the out-of-pocket limit. People with Extra Help won’t get the donut hole. This program will pay the Part D costs.

Shrinking the Donut Hole

How do you apply for Medicare Part D?

The Affordable Care Act added funds to Medicare to help shrink the donut hole. The effects will be nearly gone by 2018 and gone completely by 2020.

The reduction in the amount Medicare recipients must pay gets better each year. In 2016, it is 45 percent with 95 percent credit towards out-of-pocket expenses.

Finding Part D Plan

Medicare provides an online plan locator to list the available programs in a given area. The locator tool allows users to input the drugs they use to get a precise idea of the costs and savings from the plan options.

Applicants can do this by phone or at a local Social Security office with help from counselors.

Signing Up for Part D

How do you apply for Medicare Part D?

Applicants can apply for Medicare Part D – Prescription Drug coverage online, at a local social security office, by telephone, and by hard copy mail.

Applicants can apply during the initial signup when they qualify and sign up for social security benefits. They can apply during the Part C open enrollment October 15 through December 7. Applicants can sign up in a special enrollment period. After open enrollment, applicants may still apply to a five-star rated provider in their geographic area. Comparison shopping is an effective approach to selecting stand-alone drug plans and Medicare Advantage with prescription drug coverage.

By researching drug information for their current prescriptions, consumers can see the prices that they will pay under a particular plan and coverage. In this way, they can assess the true savings when adding premiums, subsidized prescription prices, and copays.

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