Medicare Part D
Medicare prescription drug plans are available for anyone with Medicare. There are many different drug plans available in Illinois. These drug plans are approved by Medicare, but administered by private companies.
When you join a Medicare prescription drug plan, you are still in Medicare. Prescription drug plans provide assistance with some or all of your medication needs, depending on the plan that you choose.
Annually, between October 15 through December 7, Medicare beneficiaries may enroll in a prescription drug plan, and currently enrolled beneficiaries can change plans if there is one that better meets their drug needs. Except under certain circumstances, beneficiaries will not have another chance to enroll or switch to a better drug plan until the following year.
Medicare beneficiaries who are satisfied with their current prescription drug plan do not have to do anything. Crucial factors when deciding whether your current drug plan serves your needs are the monthly costs and whether your medications will continue to be covered by the plan next year. Medicare prescription drug plans can change their medication list, also known as a formulary, with Medicare’s approval.
In order to meet most prescription drug needs, Medicare allows private insurance companies to issue Medicare-approved prescription drug plans. These drug plans do not cover all prescription drugs. Beneficiaries should choose the plan that best covers their own prescription drug needs. Here are some basic rules to remember.
- Beneficiaries usually pay a monthly premium for their drug plan, depending on the plan chosen.
- Beneficiaries are not required to enroll in Part D, but if they enroll later they will pay a higher monthly premium, 1% more for each month they wait. For example, if a beneficiary waits ten months, they pay 10% more than what others pay for the same drug plan.
- The premium penalty does not apply to beneficiaries who have comparable coverage from another source that have certified in writing that they are credible coverage or coverage that is at least as good as Medicare. This includes VA, Federal, and most employer drug plans.
- Most Medicare-approved drug plans require that beneficiaries pay an annual deductible before the plan pays anything (see the maximum amount in row “1.” in the chart below). However, some drug plans have no annual deductible.
- Most beneficiaries pay 25% of the drug costs after the deductible has been met (see row “2.” in the chart below). Some drug plans charge less than 25%.
- Most beneficiaries pay 25% of the drug costs after the deductible has been met (see row “3.” in the chart below). However, some individual drug costs may be different during this phase of coverage.
- Most beneficiaries pay 5% or less of the costs after their annual drug costs exceed the amount described row “4.” in the chart below. You may pay less under some drug plans during this phase of coverage.
- Source: DHHS Centers for Medicare & Medicaid Services.
- FPL means Federal Poverty Level.
- Income amounts above do not include $20 disregard allowed in Illinois.
- Assets do not include up to $1,500 for burial expenses ($3,000 for couples) whether or not they have been set aside for this purpose, nor burial plot, home, car, household items, or term-life insurance.
- Sources: Illinois SHIP & Medicare Rights Center
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