How Do I Get Part D Prescription Drug Coverage?

Medicare Part D is the government program that was put in place to offer prescription cost sharing for Medicare beneficiaries. To get coverage, you must purchase a plan from a private insurance company approved and contracted by Medicare. However, there are some things to consider before choosing a prescription drug plan. Learning how to add Part D prescription drug coverage as part of your Medicare will help you spend less time trying to figure it out and more time doing the things you enjoy.

How to Add Medicare Part D

There are basically two ways to add Medicare prescription drug coverage. Adding it as a stand alone plan to your original Medicare or by joining a Medicare Advantage Plan, which falls under Part C of Medicare. Both of these options are available through your private insurance company. However, plans vary by cost and availability of drugs. Be careful when choosing a plan that not only keeps to your budget, but that your drugs are covered and there is a participating pharmacy near you.

Medicare Prescription Drug Plans (PDPs)

Medicare prescription drug plans, also called PDPs, add a prescription plan to your original Medicare coverage. In Illinois, there are currently 35 stand-alone Medicare Part D prescription drug plans to choose from. Enrollment is easy. For instance, Blue Cross and Blue Shield has three plan options available in Illinois. They are PDP plans approved by Medicare. Joining is as easy as picking up the phone and calling a Blue Cross and Blue Shield representative for more information. They will guide you through the process and explain the nuances of Part D as well as the plan offerings.

Medicare Advantage Plans (HMO or PPO)

These Plans are run by private insurance companies which take away your Original Medicare Part A and Part B and places them into one plan along with a prescription drug plan. These plans are sometimes referred to as MA-PD’s and tie you into the insurance company’s network, unlike Original Medicare that has no networks. So you are tied to live in the service are of the plan.

Specific Timeframes

There are very specific times when you can join a Medicare drug plan. In addition to these set out times, there are special enrollment periods that take into consideration if you move out of the coverage area, if you live in a nursing home or if you lose prescription drug coverage.

Annual Enrollment Period

In 2018, the Annual Enrollment Period is October 15th through December 7th. This Annual Enrollment Period is the time of year that Medicare beneficiaries join, switch or drop a Medicare drug plan. This timeframe is designed to give Medicare ample time to get your paperwork together so your request can be active by January 1st of the following year.

Initial Enrollment Period

This is the 7-month period of time when you are first eligible to join Medicare. Typically, it begins 3 months prior to the month of your 65th birthday and extends three months after you turn 65.

Disability Period

This is the period of time that begins 3 months before your 25th month of disability and extends until 3 months after your 25th month of disability.

It may sound confusing, however, it‘s really not as long as you are prepared. Check the availability of plans you are interested in, make certain that your prescription drugs are covered by that plan and locate participating pharmacies in your area. Adding prescription drug coverage to your Medicare plan is easy as long as you understand how to pick a plan that fits your needs.

Once you have a better understanding, it is vital to sit down with a Medicare Part D trained and certified professional. Healthcare Services of Illinois’ (HSOI) licensed insurance specialists are Medicare Part D trained and certified and regularly guide its clients through the Medicare maze ensuring that they understand their options, cost structure, coverage and find the most appropriate plan.