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FAQs About Medicare Part D

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.

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.

How do I get the specific information I need to choose a plan?

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 website.

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.

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 https://secure.ssa.gov/i1020/start .

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 October 15 through December 7. 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 website, customer service center, and 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 Therapeutics 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) - except when used to treat epilepsy, cancer, or a chronic mental health disorder

In addition, a drug cannot be covered under a Part D plan if payment for that drug is available under Part 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.

If I live in one of the U.S. territories, will I have access to a Medicare Part D plan?

Yes. Medicare Part D plans are available in the U.S. territories.

Will Part D cover drugs purchased from Canada?

No. Only drugs sold in the United States are eligible for Part D 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 had 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.