To enroll in Medicare Part D prescription drug coverage, you must choose from private plans available in your service area The service area is the geographic area where a Medicare Advantage Plan or Part D plan provides medical services to its members. In many plans, the service area is where your network of providers is located. .
How to choose a Part D plan
Make sure to look at all the costs, including the deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. , , and copayments/ coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. . Your costs throughout the year will depend on which drugs you take, whether your plan covers them, and whether there are any coverage restrictions. You may want to have a list of questions to ask about each plan to help ensure your needs are met.
Ways to receive Part D benefits
How you can get drug coverage depends on how you get your Medicare health benefits:
- Original Medicare: If you have
Original Medicare
Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare.
, you will typically enroll in a stand-alone Part D plan to receive drug benefits.
- If you are enrolled in a Medicare Medical Savings Accounts (MSA), Private Fee-for-Service (PFFS) plan A Private Fee-for-Service (PFFS) plan is a type of private insurance plan. Some Medicare Advantage Plans are PFFS plans. PFFS plans have provider networks, and you pay less for your care when using in-network providers or facilities. All PFFS plans must also cover out-of-network care, but you may pay a higher cost. See also: Medicare Advantage. without drug coverage, or Medicare cost plan A Medicare Cost Plan is a type of Medicare health plan available in certain, limited areas of the U.S. It is not a Medicare Advantage Plan. Cost Plans have networks, but they provide for coverage outside of the network through Original Medicare. If you get out-of-network care from a Medicare provider, Original Medicare will cover the services. You will pay the Part A and Part B deductibles and coinsurances for any services covered by Original Medicare. , you can also join a PDP.
- Medicare Advantage Plan (such as an HMO or PPO): If you are enrolled in an MA Plan, it will typically provide your drug benefits as well as your health benefits.
Part D enrollment
In most cases, you can only enroll in prescription drug coverage during certain enrollment periods. It is a good idea to enroll early during an enrollment period to make sure that your new coverage starts when it should.
Note: If you have Extra Help or live in a nursing home A nursing home, also called a long-term care facility, is a residential facility for people with chronic illness or disability. Nursing home services include room and board, nursing care, personal care, and therapy services. A skilled nursing facility (SNF) is a nursing home that provides skilled care, but not all nursing homes are SNFs. Medicare does not cover the cost of nursing homes that are not SNFs. , you will have the option of changing your drug Part D coverage once per month.
To enroll in a Part D plan, you can do any of the following:
- Call 1-800-MEDICARE (1-800-633-4227). Counselors are available to guide you through your options and enroll you in a plan. It is a good idea to enroll through 1-800-MEDICARE to avoid administrative errors.
- Use Medicare’s Plan Finder tool to compare plans and enroll.
- Call the plan you wish to enroll in, and a representative can help you.
Know that you can choose to have the Part D premium, which varies by plan, taken out of your monthly Social Security check, or you can pay your plan directly each month. If you choose to have your premiums withdrawn from your Social Security check, you may sometimes notice a delay in payment. However, your plan cannot disenroll you or bill you for the premium because of that delay.