Medicare Part D Prescription Drug Plan Enrollment
When youre eligible to enroll in Original Medicare, you also become eligible to enroll in a Medicare Part D prescription drug plan.
If you want Medicare prescription drug coverage, you typically have two options:
- Enroll in a Medicare Advantage plan that includes prescription drug coverage
- Enroll in a Medicare Part D standalone prescription drug plan
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent.
You can also enroll in a prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.1
I Currently Have A Medicare Advantage Plan And A Stand
- Switch from your current Medicare Advantage plan to another Medicare Advantage plan with or without built-in drug coverage.
- Switch from your current Medicare prescription drug plan to another Medicare prescription drug plan.
- Drop your Medicare Advantage plan and go back to Original Medicare.
- Drop Medicare prescription drug coverage completely. Note that you may be charged a penalty if you decide you want drug coverage again later.
- Make no changes and your current coverage will renew as is.
AEP is also a great reminder to review your Medicare plan each year so you can make sure you have the coverage you need going forward.
Fact : Medicare Isnt Free
And it doesnt cover everything.
It pays to do a little math. Review your expenses from last year so you can anticipate what your future needs may be.
Original Medicare includes hospital and medical care, but it doesnt cover prescription drugs or routine vision, dental or hearing care. Do you take daily medications? Do you wear glasses or contacts or need hearing aids? Youll be paying out of pocket for those items. However, your deductibles and copays may be lower if youre enrolled in a Medicare Part C plan.
Many Medicare Advantage plans include coverage for prescriptions and may and . You may need to pay a monthly premium, in addition to the Part B premium, but it may be worth it based on your needs.
An unexpected hospital visit, or a toothache that turns into a root canal, could quickly blow your budget. Compare the coverage and cost options from the government and private insurers, like Humana, to make sure youre getting the coverage you need.
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How Do People Know If They Need To Change Plans
People in a Medicare health or prescription drug plan should always review the materials their plans send them, like the Evidence of Coverage and Annual Notice of Change . If their plans are changing, they should make sure their plans will still meet their needs for the following year. If theyre satisfied that their current plans will meet their needs for next year and its still being offered, they dont need to do anything.
What Changes Can I Make During Aep
During the Medicare Annual Enrollment Period, you can make changes to your Medicare Advantage and Cost Plans, and Part D prescription drug plans only. Multiple changes and updates are allowed, including:
- Dropping your Medicare Advantage Plan and returning to Original Medicare
- Moving from Original Medicare only to a Medicare Advantage Plan
- Enrolling in a different Medicare Advantage Plan
- Adding a Part D prescription drug plan if you dont have one
- Cancelling your current Part D prescription drug plan
- Note: If you dont maintain some form of creditable prescription drug coverage and decide to re-enroll in Part D in a later year, youll get dinged with a late-enrollment penalty.
There isnt any special flexibility to add or adjust your Medicare Supplement plan during AEP. If you choose to change your Supplement plan during AEP, the same rules apply as they would during the rest of the year.
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What Are The Medicare Enrollment Periods
Enrollment periods are designated time periods to enroll or disenroll from the various parts of Medicare. There are six Medicare enrollment periods.Medicare.gov, When does Medicare coverage start?, Accessed September 25, 2021Medicare.gov, Joining a health or drug plan, Accessed September 25, 2021
Do I Plan On Traveling This Year
If you travel out of state or even the country, you may not be able to see your preferred physician in the event of an illness or emergency. Make a list of where you plan to travel or if you move between two or more homes throughout the year. Then, verify that your plan has providers in network within these areas where you can establish care.
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What Is The Medicare Open Enrollment Period
Medicare Open Enrollment Period can mean different things depending on how you use it. As mentioned above, it is often used to refer to AEP. But there is also a Medicare Advantage Open Enrollment Period . As the name implies, changes during this time are limited to Medicare Advantage Plans and are only available to those that are currently enrolled in a Medicare Advantage plan.
What Can You Doduring The Medicare Oep
What Medicare OEP allows you to do depends on what plan youre referring to. For instance, Medicare Advantage OEP allows you to make changes only if you are already enrolled in Medicare Part C .
Medigap allows you to enroll at any point of time in a year. However, you have to answer a few health questions first. Medigap OEP allows you to enroll in Medicare Supplements without the need to answer any of those questions.
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Can I Sign Up For Social Security But Not Medicare
The two are linked because the Social Security Administration will automatically enroll you in Medicare at age 65 if you are already receiving social security payments, but you dont have to remain enrolled.
How do I know if I am signed up for Medicare? If youre drawing social security before age 65, you should receive a Medicare card from the SSA in the mail shortly before your 65th birthday. The welcome packet will include instructions on how to decline enrollment into Medicare.
Understanding Medicare Annual And Open Enrollment Periods
The Medicare terms Annual Enrollment Period and Open Enrollment Period are often used interchangeably, but they dont always mean the same thing. The AEP and OEP are annual fixed windows during which individuals can enroll in Medicare or revise their existing Medicare plans.
Insurance companies that provide Medicare Advantage Plans and Medicare Part D plans make annual changes to their offerings. The changes may affect the cost of your insurance plan, your coverage, and your choice of in-network health care providers and drug stores, among other features.
These updates are communicated a few weeks prior to the start of the enrollment periods via an Annual Notice of Change that is mailed to your home. The ANoC features all the changes that will affect your plan for the coming year.
As a beneficiary, youre required to carefully review the changes and decide whether the plan will continue to meet your coverage needs. If youre not satisfied with the changes, you can choose to drop the plan, switch it to a more suitable alternative, or purchase extra coverage.
It is important to be aware of these two annual enrollment periods. If you miss them, you wont be able to sign up or make changes to your plan until the following year, unless you experience an event that qualifies you for special enrollment.
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What Changes Can I Make During The Annual Enrollment Period
One of the major differences between the AEP and OEP is the type and number of changes you can make to your plan. As previously explained, you can only make one change to your Medicare Advantage Plan during the OEP.
However, the AEP allows you to make multiple adjustments to an array of Medicare plans whenever you feel that the insurers changes will affect your health coverage in some way. During the AEP, you can
- switch from an Original Medicare Plan to a Medicare Advantage Plan. Dissatisfied beneficiaries can switch from Original Medicare to Medicare Advantage and vice versa without any penalties.
- switch from one Medicare Advantage Plan to another. You can switch between HMOs, PPOs, PFFS plans, SNPs, and MSAs during the AEP.
- switch from a Medicare Advantage Plan without prescription drug coverage to one that includes prescription drugs and vice versa.
- switch from one prescription drug to another based on your current needs.
- drop your current providers plan and enroll in a different plan with a new provider.
Why Would I Want To Make Changes
- the cost of your plan
- whats covered under your plan
- which healthcare providers and pharmacies are considered to be in network for your plan
Because of this, your current health or drug plan may no longer be a good fit your health or cost needs for the coming year. During AEP, you can select a different health or drug plan for the next year that works better for you.
If your plans provider is making changes to your plan, theyll send you an annual notice of change form. This explains the changes that will be included in your plan for the upcoming year.
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Enrolling In Medicare Advantage
To join a Medicare Advantage Plan, you will need to have Original Medicare coverage and live in an area where an Advantage plan is offered.
A Medicare Advantage plan will wrap your Medicare Part A and Part B coverage into one plan. But youll still have to pay the government a premium for Part B, in addition to the premium you pay for Medicare Advantage .
You can enroll in a Medicare Advantage plan when youre first eligible for Medicare, or during the annual Medicare open enrollment period in the fall .
Medicare Advantage Plan Enrollment
When youre eligible to enroll in Original Medicare, you also become eligible to enroll in a Medicare Advantage plan. You need to enroll in Original Medicare before you enroll in Medicare Advantage. Before enrolling in a plan, it may be a good idea to compare Medicare Advantage quotes.
To be eligible for Medicare Part C, you must already be enrolled in Part A and Part B.
If you are interested in joining a Medicare Advantage plan, you typically can only do so during specific times of the year.
The first time you may be able to enroll is during your Medicare Initial Enrollment Period, as outlined above.
If you sign up for a Medicare Advantage plan during your Initial Enrollment Period, you can change to another Medicare Advantage plan or switch back to Original Medicare within the first 3 months that you have Medicare.
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What Is The Medicare Annual Enrollment Period
Medicare Annual Enrollment Period , also known as the Medicare Annual Election Period and the Medicare Open Enrollment Period, is a specific fall enrollment period from Oct. 15 through Dec. 7 . During this time, beneficiaries can make changes to their current Medicare plan coverage. All plan and benefit changes become effective on Jan. 1 the following year.
On Oct. 1 each year two weeks before Medicare open enrollment starts health insurance companies release information about their plan benefits for the following year. These can include premium changes, prescription drug coverage updates and more. This is a great time for Medicare beneficiaries to think about whether their plan will still meet their needs in the next year. If not, they can look for a better option during AEP.
You can make these changes without any review of your medical history, as you might need to do when switching Medicare Supplement plans.
When Does The Aep Take Place Each Year
AEP happens every year from October 15 to December 7.
During this time, you can make changes to your plans in order to best meet your needs for the upcoming year. These changes will go into effect starting on January 1.
If the provider of your current plan has made changes that affect things like cost and coverage, theyll send you an ANOC. Youll typically receive this by mail sometime in September.
Information about the different Medicare health and drug plans for the upcoming year will become available beginning in October. This gives you time to review and compare different plans before AEP begins on October 15.
In addition to AEP, there are several other Medicare enrollment periods when you can make certain changes to your plan.
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Medigap Open Enrollment Period
Medigap is also called Medicare supplement insurance. It helps cover some of the expenses under original Medicare.
The Medigap open enrollment period lasts for 6 months. It begins when both of the following are true:
- youre age 65 or older
- youve enrolled in Part B for the first time
Medigap can only be used with original Medicare. If you have a Medicare Advantage plan, you cannot enroll in Medigap.
Enrolling In Original Medicare
If youre already receiving Social Security or Railroad Retirement Board benefits and youre a U.S. resident, the federal government automatically enrolls you in both Medicare Part A and Medicare Part B at age 65. Youll receive your Medicare card in the mail about three months before you turn 65, and your coverage will take effect the first of the month you turn 65.
Medicare Part B has a monthly premium, which will be deducted from your Social Security or Railroad Retirement check. The standard Part B premium is $170.10/month for 2022. Thats up from $148.50/month in 2021, and quite a bit higher than initially projected in the Medicare Trustees Report projects. But the Social Security cost-of-living adjustment for 2022 is the largest its been in 30 years, and will cover the increase in Part B premiums . However, the larger-than-expected increase in Part B premiums will eat up a significant portion of the Social Security COLA that many beneficiaries receive.
You can opt out of Part B and avoid the premiums, but its generally only a good idea to do that if youve got health insurance from your current employer or your spouses current employer, and the employer has at least 20 employees.
If youre disabled and receiving Social Security Disability benefits, your Medicare coverage will start automatically in the 25th month that youre receiving disability benefits.
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Medicare Part D Prescription Drug Coverage
2022 Part D premiums:
- The average premium for stand-alone Medicare Part D coverage is about $43/month in 2022. There continue to be a wide range of Part D plan options available. Premiums for Part D plans start as low as about $7/month in 2022. On the higher end, plans can have premiums of up to $100/month or more, so there is a great deal of variation in price and benefits across the available plans.
- High-income enrollees pay a higher Part D premium. The threshold for high-income began to be indexed as of 2020. The income threshold for 2022 is $91,000 for a single person and $182,000 for a couple . In 2022, the additional premium for high-income enrollees ranges from $12.40/month to $77.90/month.
Part D deductible:
- Maximum of $480 in 2022, up from $445 in 2021. .
Part D out-of-pocket costs after deductible:
- Not to exceed 25% of the cost of brand-name and generic costs.
- There is no longer a donut hole in terms of the maximum amount that enrollees can be charged when they fill prescriptions. But the donut hole still exists in terms of how insurers design their coverage , how total drug costs are counted, and who covers the bulk of the cost of the drugs .
- After a beneficiarys costs reach the catastrophic coverage threshold , additional out-of-pocket costs are capped at the greater of 5% of the cost of the drug or a copay of $3.95 for generics and $9.85 for brand-name drugs.
Learn more about Medicare Part D.