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If you have decided to enroll in Medicare Part D, how do you
decide which plan to join? No matter where you live in the United
States (including Puerto Rico), you have a wide range of choices.
First, you need to decide whether to
- stay with Medicare (which covers your doctor, hospital, and
some other services) and enroll in a Part D plan
or
- enroll in a private health insurance plan that has
contracted with Medicare to provide the full range of Medicare covered
health care, including drug benefits.
This second option is known as Medicare Advantage. Medicare
Advantage plans may be health maintenance organizations (HMOs),
preferred provider organizations (PPOs), or private fee-for-service
plans. There are also some Medicare Advantage Plans designed for people
with special needs, such as long-term care needs. The Part D drug
benefit offered with a Medicare Advantage plan is known as a Medicare
Advantage Prescription Drug Plan or MA-PD. You can learn more about
Medicare Advantage in Medicare
& You 2009 which you can find at
www.medicare.gov.
To get a copy of this handbook, call 1-800-633-4227
(1-800-MEDICARE)
Whether you elect a stand-alone Part D plan or a Medicare
Advantage Plan that includes the Part D prescription drug coverage
(MA-PD), you may want to think about all your choices (called the
beneficiary choices) based on who you are insured through. (See the
next section.)
Beneficiary choices
These are some of the options you may have when looking at
Medicare Part D and other types of drug coverage.
Your current plan through an employer, a union, or the
military
- Check with your benefits administrator about your options.
- The plan must be "as good as or better than" the standard
Part D plan to avoid future penalties if you later enroll in Part D.
- If you decide
to keep your current coverage, be sure to get/keep a
letter as proof of creditable coverage.
- If you decide
to change to Part D or should you lose your coverage, you
MUST join a Part D plan before going 63 continuous days without
coverage or risk a late enrollment fee. The late enrollment penalty
will raise the cost of your coverage for as long as you have it.
Medicare A or B or both
- If you are
new to Part D, you must enroll during your initial
enrollment period unless you have "as good as or better" coverage as
discussed above. You have 6 months: 3 months before you turn 65 through
3 months after you turn 65. If you DO
NOT join when first eligible, you will have to pay a late
enrollment penalty for as long as you have Medicare.
- If you
already have Part D, review your coverage every open
enrollment period (November 15 to December 31). If you want to switch
plans you MUST
do so during this time except in certain situations (if you move or go
into a nursing home, for instance.) If you are happy with your coverage
and its premium, and the plan is still offered in your area, you don't
have to do anything to keep the same coverage.
- If you have a
Medigap policy, drug coverage under Medigap is not as good
as coverage under Medicare Part D. If you don’t join a Part D
plan when first eligible you may have to pay a late enrollment penalty
if you choose to join later. You can’t have Medigap
prescription drug coverage and Medicare prescription drug coverage at
the same time.
Medicare Advantage Plans: HMOs, PPOs,
private fee-for service, Medical Savings Accounts
- If you belong to a Medicare Advantage HMO or PPO, you can ONLY get
prescription drug coverage from your plan. If you join a Part D plan
you will automatically lose your Medicare Advantage HMO or PPO.
- If you have a private fee-for-service plan or a Medicare
MSA plan that does NOT
offer drug coverage, you may join a Part D plan.
- You can join or switch Medicare Advantage Plans from
January 1 through March 31, of any year, but you CANNOT drop Part D
drug coverage during this time.
Medicaid
- If you have both Medicaid and Medicare, you are said to be dual eligible. If
you do NOT
join a Part D plan, Medicare will automatically enroll you in a plan.
You will get a letter telling you the plan you have been enrolled in
and when your coverage begins.
- If Medicare enrolls you in a plan, you may switch Part D
plans at any time. It is a good idea to look at the plans available to
you and be sure you are in the one that best meets your needs.
Last Medical Review: 10/23/2008
Last Revised: 10/23/2008
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