Home > Pharmacy > Medicare Prescription Drug Coverage > FAQ's
FAQ's
- Why is there a late enrollment fee?
- Who is eligible for Medicare Part D prescription drug coverage?
- Do I have to participate in a Part D plan?
- How do I know if I should sign up?
- This book is a good start, but how do I get the specific information I need to make a decision?
- How do I find out if I qualify for help?
- What assets will be counted to determine if I am eligible for help?
- Can I change Part D plans once I have enrolled?
- How will I know if the drugs I currently take will be covered?
- Who decides which drugs will be covered on a formulary?
- What drugs are excluded from Part D plans?
- Will Part D cover drugs purchased from Canada?
- Can premiums be deducted from Social Security checks?
- What is creditable coverage?
- Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?
- I have drug coverage through the Veterans' Administration (VA). Can I continue to get my prescriptions through the VA?
- If I live in the U.S. territories, will I have access to a Medicare Part D plan?
- I take several different prescription drugs. Will there be help with managing all my medications?
- Where can I get more information?
Why is there a late enrollment fee?
Congress believes that unless you already have creditable prescription drug coverage, Part D plans are a great way for you to get help with the cost of prescription drugs. They crafted the rules to encourage people to enroll in the beginning instead of waiting to join only when health problems develop and drug costs rise. The late enrollment fee gives people a reason not to postpone the decision to join.
Who is eligible for Medicare Part D prescription drug coverage?
All individuals with Medicare Part A or Medicare Part B are eligible to enroll regardless of age, income or health conditions.
Do I have to participate in a Part D plan?
No, you do not have to participate. It is your choice. However, similar to other types of insurance, the longer you wait, the higher your premium will be.
How do I know if I should sign up?
You will need to review your options carefully to see if a Part D plan is right for you. Part D plans are designed to provide financial savings to most people with Medicare. As insurance plans, they provide protection against future, unexpected costs. They also provide additional financial assistance for people with lower incomes.
This book is a good start, but how do I get the specific information I need to make a decision?
In October, you will begin to receive specific information about the options available to you. First, you will receive the Medicare & You handbook, which will include all of the plans available in your area. Second, in October, the plans will begin releasing specific plan information, including plan costs, the list of covered drugs (formulary), and the list of network pharmacies. Information will also be available at www.medicare.gov, the Medicare Web site.
How do I find out if I qualify for help?
If you have both Medicare and Medicaid, you already qualify for low-income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance. Visit www.socialsecurity.gov.
What assets will be counted to determine if I am eligible for help?
The assets that will be counted include cash or any property that can be converted to cash within 20 days. This includes checking accounts, savings accounts, certificates of deposit, retirement
Can I change Part D plans once I have enrolled?
Yes, you can change your Part D plan. The opportunities to switch are:
- Annual enrollment: Each year, you will be able to choose a different Part D prescription drug plan or Medicare Advantage plan during an annual enrollment period that lasts from November 15 through December 31. Coverage under the new plan will begin the following January 1.
- Other exceptions: There are other limited exceptions that may give you the right to switch plans during a year. For example, if you move out of the service area of your current plan, you will have an opportunity to choose another plan that serves your new area.
How will I know if the drugs I currently take will be covered?
Each Part D plan will provide its own formulary or list of covered drugs. This information will be available through the plan's Web site, customer service center, and through marketing materials.
Who decides which drugs will be covered on a formulary?
All Part D plans must meet formulary requirements set by Medicare. The formulary will include both generic and brand name drugs. Each plan must use a Pharmacy and Therapeutic Committee, which includes doctors and pharmacists, to establish its formulary. This process assures you that you'll have access to a number of drugs, although not necessarily all drugs.
What drugs are excluded from Part D plans?
The drugs that are excluded from Part D by Medicare are:
- Drugs used for anorexia, weight loss, or weight gain
- Drugs used to promote fertility
- Drugs used for cosmetic purposes or hair growth
- Drugs used for the symptomatic relief of cough and colds
- Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
- Non-prescription drugs
- Inpatient drugs
- Barbiturates (sleeping pills)
- Benzodiazepines (central nervous system depressants)
In addition, a drug cannot be covered under a Part D plan if payment for that drug is available under Parts A or B of Medicare, such as drugs administered in a hospital or a physician's office. Also, each Part D prescription drug plan may have its own specific exclusions.
Will Part D cover drugs purchased from Canada?
No. Only drugs sold in the United States are eligible for Part D coverage.
Can premiums be deducted from Social Security checks?
Yes, you will have the option to have the premium deducted from your Social Security check (just like your Part B premium), or you or your former employer can pay your premium directly to the private company.
What is creditable coverage?
Creditable coverage is coverage, from a plan other than a Part D plan, that meets certain Medicare standards. If you currently have prescription drug coverage that is considered creditable coverage, you may keep that coverage and wait to enroll in a Part D plan. If you later decide to enroll in a Part D plan, you will not have to pay a late enrollment fee.
Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?
No, Part D coverage will not be available directly from Medicare. Although you will be able to have your premium deducted from your Social Security check, you must purchase Part D coverage from a private company that has been approved by Medicare to offer coverage.
I have drug coverage through the Veterans' Administration (VA). Can I continue to get my prescriptions through the VA?
The introduction of Part D prescription drug plans in January 2006 has no impact on Veterans' Administration benefits.Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their prescriptions through the VA.
If I live in the U.S. territories, will I have access to a Medicare Part D plan?
Yes,Medicare Part D plans will be available in the U.S. territories.
I take several different prescription drugs. Will there be help with managing all my medications?
Yes, one of the advantages of Medicare Part D plans is that there will be help managing drugs for people who take multiple medications, have chronic diseases, such as diabetes or heart disease and high drug costs. The help is designed to make sure that your medications work well together and reduces the risk of a bad reaction. You might also hear this called medication therapy management.
Where can I get more information?
You can start by downloading the "Medicare Prescription Drug Guide" for information about choosing a Medicare Prescription Drug Plan. If you still have questions and concerns, talk to your physician or pharmacist. Use the "Rite Aid Medicare Advisor" or the "Medicare Plan Finder" tool to find a plan that meets your needs.
