Medicare Prescription Drug Plans

Many people do no realize that they need to opt into prescription medication coverage when enrolling in Medicare.  There is a lot to know and learn about when you are considering Medicare Prescription Drug Plans.  Verus Health Partners is here is help you navigate the process!

Medicare Part D

If you are eligible for Medicare, you have the option to enroll in Medicare Part D to get help with prescription drug costs.

Medicare prescription drug coverage is available in two ways. If you have orignal Medicare Part A and Part B, Part D will not  be automatically included (except for some exceptions). To get this coverage, you enroll in a stand alone prescription drug plan (PDP) or a Medicare Advantage Plan (MAPD) with drug coverage.

Part D coverage is available through private companies, with varying costs.

Keep in mind that there is a penalty associated with your Part D, if you do not have a Medicare Plan with prescription drugs, or other creditable coverage. (Please contact us for more information on creditable coverage)

Enrollment in a Medicare Advantage Plan (Part C), with drug coverage, also provides you with creditable drug coverage.  These types of  plans give you the option to get health and drug coverage all under one plan.


Medicare Prescription Drug Plans

Eligibility and Enrollment

Two options to consider when determining your eligibilty for Part D coverage. 

First, if you are enrolled in Medicare part A and/or eligible/enrolled in B and live within the plan’s service area you can enroll in a Medicare PDP.

Secondly, you will need to be enrolled in both Medicare Parts A and B, and live within the plan’s service area in order to be eligible to enroll in a Medicare Advantage Plan (MAPD).

Depending on your circumstances, you may enroll in a stand alone drug plan, or a Medicare Advantage plan during certain qualifying election times.

When Can You Enroll

There are certain times when you can enroll in Part D coverage to avoid late enrollment penalties.  These include:

  • Initial Enrollment Period for Part D: This is the time period when you become eligible for Medicare – generally three months prior to your 65th birthday.  If you are younger than 65 and are on disability, you qualify after the 25th month of benefits are paid, and are eligible for up to seven months.
  • Annual Election Period: Each year there is an open enrollment period from October 15 to December 7.  This timeframe is for you to make changes to your Medicare coverage.
  • Medicare Advantage Open Enrollment Period: From January 1 to March 31 you can choose to leave Medicare Advantage and opt back into Medicare Part A and B, often known as original Medicare.  You can also use this time to enroll into Part D, but cannot make any changes to existing Part D coverage.
  • Special Election Period: There are certain qualifying life events such as moving into a nursing home, moving outside of the plans coverage area, loss/gain of Extra Help (LIS), Medicaid eligbility etc. that may make you eligible to enroll in Part D coverge.
Medicare Prescription Drug Plans

Medicare Part D late-enrollment penalty

If you’re not currently taking prescription medications, it is still a good idea to sign up for Medicare Part D once  you become eligible. If you don’t enroll in Medicare Part D, make sure you have other creditable prescription drug coverage, which is insurance that is as good as the standard Medicare prescription drug benefit. If you don’t enroll in Medicare Part D when you’re first eligible and go without creditable prescription drug coverage for 63 days in a row or more, you could face a late-enrollment penalty if you sign up for Part D later on. This penalty comes in the form of an extra cost that is added to your monthly Medicare Part D premium; you may have to pay this higher premium permanently.

Information for Medicare -
Verus Health Partners Can Help

At Verus Health Partners, we educate our clients.  Our goal is to ensure you have the proper coverage for your situation.  Contact us today to learn more about the Medicare plan parts and what you qualify for.  We will help you determine the right combination for you based on your specific needs.  You can follow us on Facebook for other helpful information.