Fact: Open to Anyone with Medicare
Medicare Part D plans are open to everyone eligible for Medicare in the U.S. and U.S. territories. Generally, that means anyone 65 years old or older and some younger people with certain disabilities. You cannot be denied coverage for health reasons. Participation is voluntary, which means you get to decide if you want to enroll or not. If you have Medicare and Medicaid, you will be enrolled automatically, so there is no lapse in your Medicaid prescription drug coverage. The annual open enrollment period is October 15 to December 7, for coverage beginning January 1. If you decide to join later, your monthly premiums may be higher because there's an additional fee for late enrollment.
Fact: You Pay to Participate
Participation in Medicare Part D has a cost and you will pay a portion. However, much of the cost is paid for by the government. Typically, the government pays about 75 percent of the enrollment costs of your chosen plan and you pay the rest.
Fact: Participation Means Peace of Mind
All of the Part D plans are private insurance plans. Most participants will pay a monthly premium, but that premium buys you the peace of mind of knowing that if your drug costs become very high, you will be protected.
Fact: Plan Members Can Access Discounted Prices
If you join a Part D plan and use the plan's network pharmacies, you'll have access to discounted prices. Plans often negotiate lower prices with drug companies and pass those savings along to you.
Fact: You Choose Your Plan
When you enroll in Medicare Part D, you can choose which plan best meets your needs. Companies release details of their plans after October 1 each year, and you’ll be able to change your plan once a year. Although every plan must meet the government’s basic requirements, there will be differences among different plans, including what drugs are covered and what pharmacies you can use.
Fact: There Are Two Types of Plans
Plans come in two basic types. The most simple is a prescription drug plan (sometimes called a PDP), which covers only drugs and can be used with your traditional Medicare and/or a Medicare supplement plan. The other type combines a prescription drug plan with a Medicare Advantage plan and includes medical coverage for doctor visits and hospital expenses. This kind of plan is called Medicare Advantage plus Prescription Drug, or MA-PD.
Fact: Enroll Late, Pay More
If you do not enroll when you first become eligible, you may pay more when you sign up later. The late enrollment fee is approximately one percent of your premium for each month you delay, and you'll pay it for as long as you stay in a Part D plan. If you enroll late because you were participating in a qualified prescription drug plan, such as a plan from your former employer, the fees may not apply to you. Additionally, if you are eligible for the low-income subsidy, the fee may not apply.
Fact: Each Plan has a Drug Formulary
Each Part D drug plan will have its own government-approved list of the drugs it covers, called a formulary or preferred-drug list. The formulary may vary from plan to plan, but you and your doctor will have choices. Before you choose a plan, you'll probably want to compare plan formularies to see which one best fits your needs.
Fact: Drugs are not free of charge, but the cost will be significantly reduced
Although your drugs won’t be free of charge, the cost will be significantly reduced. For each prescription, you'll pay a portion of the cost. Your plan will help you with some of the costs, but how much you pay and how much your plan pays will vary.
Fact: There Is Extra Help Available for People Who Need It
If you have a lower income, you may be able to get extra help. Your premiums may be reduced or eliminated, and other payments may also be less.