Enrolling in Medicare Advantage and Prescription Drug Plans

Enrolling in Medicare Advantage and Prescription Drug Plans

Are you turning 65 in the next year? It’s time to consider your Medicaid options. Here are the facts:

At age 65, you are automatically enrolled in Medicare Part A, hospitalization coverage, which is free, and Part B, which covers lab fees, physician’s fees and medical equipment. There’s a premium for Part B.

If you want additional benefits, though, you will need to specifically opt into a Medicare Advantage plan (part C), and or a prescription drug plan (Part D).

Medicare Advantage

In addition to the basic Medicare benefits, Medicare Advantage plans may also provide additional benefits, such as dental, vision, expanded hospitalization benefits, or more focused care for those with special medical needs, such as diabetics.

Premiums vary, depending on your plan and location. You can’t be turned down for Medicare Advantage, but you may have to pay extra if you don’t sign up when you’re first eligible.

Note: Don’t get Medicare supplemental coverage if you already have a Part C plan. You don’t need both kinds of coverage – just one or the other.

Some things to keep in mind:

  • You can only enroll during your open enrollment period, during certain times of the year.
  • Once you enroll, you stay in the plan for a year.
  • Different plans cover different procedures and treatments. Look at their list of exclusions, or check with the plan before getting a treatment or service.
  • Managed care plans typically come with a list of authorized providers. If you have a preferred physician or other care provider, consult your plan network to ensure your preferred provider is a member of the network.
  • You may need to get a referral from a primary care physician before seeing a specialist. This is a common arrangement in HMO-type plans.

Medicare Part D

Medicare Part D is the federally subsidized prescription drug program. You aren’t automatically enrolled in Part D when you turn 65; you must specifically opt in to the program and apply for benefits. In some cases, though, your Part C, or Medicare Advantage plan, will provide prescription drug coverage as part of the plan. In other cases, you may enroll in Part D by itself (a Part D “standalone” plan), or have a separate Part C and Part D plan.

Medicare Part D requires a premium. That premium varies by plan, though. The more benefits and fewer exclusions the plan offers, the higher your monthly premium is likely to be.

Enrolling

Generally, you can enroll in Medicare Part D during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you don’t join during this initial enrollment period, though, you will generally have to pay higher premiums. You must also wait until the annual open enrollment period to sign up for benefits. Usually, this period runs from October 15ththrough December 7th.

To avoid paying penalties and higher premiums, ensure that you don’t have a break in credible coverage before signing up for a new Part C or Part D plan.

Additional rules and provisions apply for special situations, such as if you relocate, or your plan’s contract with Medicare changes.

2 Comments

  1. browsing part d plans and ran across two terms I can’t find the definitions to: “enhanced” and “full LIS” please help. thanks

    Reply
    • Hello Ron, Enhanced plans are required to have a greater actuarial value than basic plans, but plans vary in the ways in which they improve coverage. (Actuarial value is the percentage of cost covered) Enhanced plans have better coverage, but the provider may compensate these costs with higher deductibles to lower costs on certain drugs. In other words these plans are great if you have a higher personal cost for certain drugs, and the enhanced plan offer additional coverage for your needed drugs. (Check the plans formulary)
      LIS is Low-Income Subsidy (also called “Extra Help”). To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income. “Full” means you qualify for the maximum extra help. You can see if you qualify and apply here: https://secure.ssa.gov/i1020/start

      Reply

Submit a Comment

Your email address will not be published. Required fields are marked *

css.php