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Marci's Medicare Answers: March 2014

Medicare Tom Schmucker

Dear Marci,

I recently became eligible for Medicare and was told that I need to sign up for a Medicare Part D plan. What is Medicare Part D?

—Shivram

Dear Shivram,

Medicare Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. In order to qualify for Medicare Part D, you must have either Medicare Part A, the hospital insurance part of Medicare, or Medicare Part B, the medical insurance part of Medicare.

Medicare Part D is only offered through private insurance companies, and you can get Part D through one of two ways. Specifically, you can get Medicare Part D through either a stand-alone Part D plan that works with Original Medicare or a Medicare Advantage Prescription Drug plan, also known as a Medicare private health plan that provides prescription drug coverage to its plan members.

Signing up for a Medicare Part D plan is optional and is only allowed during certain enrollment periods. Keep in mind that people who do not sign up for a Medicare Part D plan in a timely manner may have to pay an enrollment penalty in the future and wait for a certain enrollment period to sign up for a Part D plan. However, some people may be able to delay enrollment into a Medicare Part D plan if they have some form of creditable drug coverage. Creditable drug coverage is coverage that is as good as or better than the Medicare prescription drug benefit. If you receive drug coverage through a different source, speak to your benefits administrator and ask whether your drug coverage is considered creditable. You should also get a written notice indicating whether or not your drug coverage is considered creditable according to Medicare’s standards.

In addition, people who qualify for Extra Help, the federal assistance program that helps to pay prescription drug costs for people with limited finances, may be automatically enrolled into a Medicare Part D plan. Bear in mind that most people who have both Medicare and Medicaid, the health insurance program that serves those with limited finances, will get Extra Help automatically, and will therefore, most likely be automatically enrolled into a Part D plan. To learn more about Extra Help, go online and visit https://secure.ssa.gov/i1020/start. You can also ask for an application by calling the Social Security Administration Hotline at 800-772-1213 or by visiting your local Social Security office.

—Marci

Dear Marci,

I’ve read articles about the doughnut hole and how Obamacare has changed drug coverage for people with Medicare. How has Obamacare impacted my Medicare prescription drug coverage?

—Ezekiel

Dear Ezekiel,

This is a great question. The Affordable Care Act (Act), also informally known as Obamacare, has actually improved Medicare prescription drug coverage for people with Medicare. Specifically, the ACA works to gradually close the doughnut hole, also known as the coverage gap, so that people with Medicare drug coverage never have to pay more than 25 percent of the cost of their covered medications at any point during the year beginning in 2020.

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