I’ve Switched to Original Medicare. How Do I Get Prescription Drug Coverage?Posted by Medicare Made Clear
Did you switch to Original Medicare during Medicare Open Enrollment Period? Maybe you’ve just become eligible for Medicare and have decided Original Medicare is right for you. What about prescription drug coverage? In general, prescription drug coverage isn’t included in Original Medicare. And coverage isn’t automatic. For this reason, many people enroll in a Medicare Part D prescription drug plan.
When can I get coverage?
Standalone Medicare Part D prescription drug plans are offered through private insurance companies. They only help pay for prescription drugs. Not all plans cover all prescription drugs, so be sure to do your research. Before choosing a plan, check its drug list—called a formulary—to make sure your drugs will be covered.
To be eligible for Part D prescription drug coverage through Medicare, you must first be enrolled in Original Medicare. There are two main enrollment periods for Part D prescription drug plans:
- Your Initial Enrollment Period (IEP) when you first become eligible for Medicare.
- The Medicare Open Enrollment Period (OEP), October 15th – December 7th.
Note: If you dropped a Medicare Advantage plan to go back to Original Medicare, you can enroll in a Part D prescription drug plan from January 1st to February 14th each year. Some people may also qualify for a Special Enrollment Period. For example, if you are losing your current prescription drug coverage for some reason, you may qualify for a Special Enrollment Period.
Do I have to worry about Part D penalties?
You might have heard about Part D penalties. What are they, and will you have to pay them? If you are without prescription drug coverage for more than 63 days in a row after you first become eligible for Medicare, you may have to pay a penalty when you finally do sign up for Part D coverage. For each month after those 63 days that you don’t have coverage, you might have to pay another 1% (of the average Part D premium). This penalty is set by Medicare and you pay it on your premium. And you will pay that penalty for as long as you’re enrolled in Medicare. So it’s definitely worth it to stay on top of your prescription drug coverage needs!
It’s not all bad news. Not everyone has to pay the Part D penalty. There are two easy ways to avoid it.
- Mark your calendar. Enroll in a Medicare Part D prescription drug plan as soon as you are eligible. Whether you’re new to Medicare or just switched back to Original Medicare, timing is important.
- Be the exception to the rule. If you have prescription drug coverage from a source other than Medicare—called creditable drug coverage—you might be able to avoid paying the Part D penalty. Creditable drug coverage might come from an employer, union or other non-Medicare source.
A few notes about creditable drug coverage: If you have prescription drug coverage from another source, get to know your benefits administrator. He or she can give you important information that can help you avoid the Part D penalty. This may include:
- If you’ll still have prescription drug coverage when you become eligible for Medicare.
- Whether or not your prescription drug coverage is considered creditable by Medicare.
- What type of proof you need to give Medicare to show that you have creditable prescription drug coverage.
Medicare Part D prescription drug coverage isn’t free. You will have to pay costs like premiums, deductibles and copays/coinsurance. These costs can vary from plan to plan. If you are worried about paying your Medicare Part D costs, help is available to those who qualify. To learn more, contact Social Security at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday, or call your state Medical Assistance or Medicaid office. You can also get more answers by calling a Medicare Made Clear representative at 1-877-619-5582, TTY 711, 8 a.m. to 8 p.m. local time, seven days a week.
Want to avoid paying the Part D penalty and find a plan that meets your needs? One helpful resource is the Medicare.gov Plan Finder tool. Just enter some basic information—like your ZIP code—to see a list of Medicare prescription drug plans available in your area. You can compare plans side-by-side to see which offers the coverage, cost and convenience you’re looking for. You can even enter the drugs you take to help estimate your costs and see only the plans that will cover your drugs. Don’t wait!
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
Medicare Made Clear: Medicare Part D prescription drug coverage
Medicare Made Clear: Need Help Paying Medicare Costs?
Medicare.gov: Plan Finder tool
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