Medicare FAQ

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Find answers to your questions about Medicare:

What is Medicare?

Medicare is health insurance offered by the federal government for people 65 and older or people under 65 with certain disabilities.

medicare-graphic

Sources:
https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf
https://www.ncoa.org/economic-security/benefits/prescriptions/part-d/

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Am I eligible for the Medicare prescription drug plan?

To be eligible for the Medicare prescription drug plan, an individual must be:
  • Entitled to Medicare benefits under Part A and/or enrolled in Part B
  • A resident in the prescription plan’s service area
  • Not enrolled in more than one Medicare Part D plan at a time.

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Should I enroll in a Medicare prescription drug plan?

  • If you have no drug coverage, or have drug coverage that is not as good as Medicare’s (i.e. not creditable), the Medicare Part D prescription drug benefit may help you. Even if you do not currently take prescription drugs, it is important to enroll to protect yourself in case your health situation changes so you do not face penalties or delays in enrolling.
  • If you are eligible for Medicare and have Medicaid, you may be automatically enrolled in a prescription drug plan. Check with your state’s Medicaid department for more information.

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When can I enroll?

You have the opportunity to obtain drug coverage when you become eligible for Medicare.
  • During your initial 7-month Medicare enrollment period (3 months before and 3 months after, as well as the month of, your 65th birthday)
  • During the 3 months before and the 3 months after your 25th month of receiving disability benefits
  • 63 days after your creditable insurance coverage ends or during the annual  enrollment period, which runs from October 15 to December 7 each year

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How do I enroll or change plans?

Once you choose a Medicare drug plan, you can enroll in any of the following ways:
  • Enroll on the Medicare Plan Finder at www.medicare.gov or on the plan's website.
  • Call 1-800-MEDICARE (1-800-633-4227).
  • Complete a paper enrollment form.

When you join a Medicare drug plan, you'll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

You can change plans during the Medicare prescription drug program's annual enrollment period, which is from October 15 to December 7 each year. (Those with both Medicare and Medicaid may change plans monthly, at any time throughout the year.)

  • You can switch to a new Medicare Prescription Drug Plan (Part D) simply by joining another drug plan.
  • You don't need to cancel your old Medicare drug plan. Your old Medicare drug plan coverage will end when your new drug plan begins.
  • If you want to join a plan or switch plans, do so as soon as possible so you’ll have your membership card when your coverage begins and can get prescriptions filled without delay. You should get a letter from your new Medicare drug plan telling you when your coverage begins.

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What if I choose not to enroll?

If you don't join a Medicare drug plan when you're first eligible to join (during your initial enrollment period), you may have to pay a late-enrollment penalty when you join. This amount changes every year but is approximately 1% of the plan's premium price for each month you delay enrolling plus a penalty for as long as you have Medicare prescription drug coverage.

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What are the costs?

You'll make these payments throughout the year in a Medicare drug plan:
  • Monthly premium
  • Yearly deductible
  • Copayments or coinsurance
  • Costs in the coverage gap
  • Costs if you get Extra Help
  • Costs if you pay a late enrollment penalty

Your actual drug plan costs will vary depending on:
  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's network
  • Whether the drugs you use are on your plan's formulary
  • Whether you get Extra Help paying your Medicare Part D costs

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Is there help available if I can’t afford a Medicare prescription drug plan?

If you have limited income and resources, you may qualify for Extra Help, a Medicare program to help pay Medicare prescription drug costs. You may qualify for Extra Help if your yearly income and resources are below these limits in 2016:

  • Single person – income less than $17,820 and resources less than $13,640 per year
  • Married person living with a spouse and no other dependents – income less than $24,030 and resources less than $27,250 per year.
  • These amounts may change in 2017.

If you qualify for Extra Help and join a Medicare drug plan, you'll:
  • Get help paying your Medicare drug plan’s costs.
  • Have no coverage gap.
  • Have no late enrollment penalty.
  • Have the chance to switch plans at any time. Any change you make will take effect the first day of the following month.

You may qualify even if you have a higher income (like if you still work or have dependents living with you). Resources include money in a checking or savings account, stocks, bonds, mutual funds and Individual Retirement Accounts (IRAs). Resources don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person) or life insurance policies.

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How do I prepare to choose a Medicare prescription drug plan?

  • Make a list of all of your current prescription drugs.
  • Visit your local fred's Pharmacy. Your pharmacist can review your current prescriptions to help determine which Part D plan option is the best for you. fred's Pharmacy does not recommend any particular Part D plan, but we do think it's important for you to take advantage of the annual enrollment period to ensure you are getting coverage that meets your needs at an affordable cost.
  • Use the eHealth comparison tool to get a list of the plans that best meet your needs in the area you live.
  • Apply for Extra Help if you have limited income and resources. There's no risk to submitting an application, and you can apply for Extra Help at any time throughout the year.

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What medications are covered?

Medications covered vary by plan. Use the eHealth tool to determine which Medicare Part D plan offers the best coverage for your current prescriptions.

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Is the plan I'm on the best option for me?

If you're currently enrolled in a Medicare Part D plan, you should think about a few things to decide if you are in “the right plan.” Each year, plan premiums, deductibles, prescription copayments and annual out-of-pocket expenses can change. These costs, as well as the list of covered drugs, vary from plan to plan and from region to region. You also need to remember that, in general, only the cost of Part D-covered drugs that are included on a plan's formulary count toward the deductible and out-of-pocket limits.

You should take time to review the various plans available to you in light of your current and anticipated prescription needs and financial resources. You may want to consider whether there is a different plan available that may be more suitable to your needs. Visit your fred's pharmacist or use the eHealth Plan Comparison tool to help determine which plan is best for you.

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Where can I get more information?

  • Visit your friendly fred's pharmacist
  • Call 1-800-MEDICARE (1-800-633-4227) to get general or claims-specific Medicare information, request documents in alternate formats, and make changes to your Medicare coverage. TTY: 1-877-486-2048
  • Visit Medicare.gov

Sources:
https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/enrolling-in-part-d-and-changing-drug-plans/should-i-enroll-in-medicare-part-d
https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf
https://www.medicare.gov/your-medicare-costs/index.html

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