Medicare will help pay for certain prescription drugs under a section of Medicare called Part D. Eligible people can choose to join a prescription drug plan run by an insurance company or other private company approved by Medicare.
Most persons will have to pay premiums, a deductible, and co-payments, but there is Extra Help from the government to pay these costs for certain low-income persons. Not all drugs will be covered. The plans vary in cost and drugs covered, and persons can choose from a selection of different plans.
Anyone eligible for Medicare Part A and/or enrolled in Medicare Part B may also enroll in the new Medicare Part D program.
Those participating in a Medicare Advantage Plan (like an HMO or PPO) may get all of their Part A and Part B coverage and prescription drug coverage (Part D) through that Plan.
Anyone whose Medicare Advantage Plan does not include prescription drug coverage can independently enroll in Part D.
Medicare Part D benefits in general
Here are some general facts about Medicare Part D:
- It will pay for about half your drug costs
- 1 in 3 people will qualify for Extra Help paying for their drug costs
- It protects you against ever having very high drug expenses
- It pays for brand-name and generic drugs
Joining a Medicare Drug Plan
If you are eligible for Medicare and you are also receiving Medicaid, SSI, or benefits from a Medicare Savings Program, you will receive drug coverage from a Medicare Prescription Drug Plan. Medicare Part D is optional for everyone else.
If you choose not to get such coverage, you will still be able to participate in Medicare Parts A and B.
You can join a Medicare Drug Plan at these times:
- When you’re first eligible for Medicare
- The 7-month period that begins 3 months before the month you turn 65 includes the month you turn 65 and ends 3 months after the month you turn 65
- If you get Medicare due to a disability, 3 months before to 3 months after your Medicare Eligibility Date
- During the annual enrollment period, which is between October 15 – December 31, with coverage starting the following January 1
- Anytime, if you qualify for Extra Help
- If you enroll in a Medicare Advantage Plan through an HMO or PPO, the open enrollment period runs January 1 through March 15 of every year
Once you choose a Medicare Drug Plan, you can join by completing a paper application, calling the plan, or enrolling on the plan’s website or on the Medicare website. You can also enroll by calling (800) 633-4227 (TTY users 877-486-2048).
In most cases, you must stay enrolled for the calendar year, starting the date your coverage begins. However, you can join, switch, or drop plans at other times, if you:
- Move out of the plan’s service area
- Lose other prescription drug coverage
- Live in an institution, like a nursing home, or
- Are eligible for Extra Help
If you want to join or switch plans, do so as soon as possible so you will have your membership card when your coverage begins, and you can get your prescriptions filled without delay.
Learn more about Choosing the right drug plan.
Applying for Medicare Part D
You apply for Medicare Part D benefits directly to the prescription drug plan of your choice, but it must be to one of the plans that cover the area where you live, and it must be during the enrollment periods.
If you decide not to enroll in a drug plan when you are first eligible, you may have to pay a penalty if you choose to join later.
Assistance and information
The federal government offers assistance through its Medicare website and through its Medicare Help hotline at (800) 633-4227.
You may also get help through the Illinois Senior Health Insurance Program (SHIP). You also can call SHIP at (800) 548-9034.
You may also call the Help Line at the Illinois Department on Aging at (800) 252-8966.
The Center for Medicare Advocacy, Inc. maintains another useful website on the new Medicare Part D.
The following also are useful websites: