Health & Benefits

Anyone enrolled in Medicare Part A, Medicare Part B, or both may also enroll in a Medicare Part D program. Medicare Part D plans help you pay for certain prescription drugs. If you choose not to get that coverage, you can still participate in Medicare Parts A and B. 

What should I know about prescription drug plans?

Eligible adults can choose to join a prescription drug plan run by an insurance company or a Medicare-approved private company. Here are some things to know about prescription drug plans: 

• If you participate in a Medicare Advantage Plan, you may also be receiving Part A and Part B coverage in addition to prescription drug coverage. So, you may not need to enroll in a separate Part D benefit. But if your plan doesn't include prescription coverage, you can still enroll in Part D.
• Medicare Part D is optional for anyone who doesn't get Medicaid, SSI, or benefits from a Medicare Savings Program. If you do receive any of these 3 benefits, you may qualify for financial assistance to pay for Medicare Part D called "Extra Help."
• 1 in 3 people qualify for Extra Help with drug costs. This program helps pay for Part D premiums Money that must be paid every month, such as for health insurance , deductibles, and co-insurance. 
• Under Part D, not all drugs are covered, but the plan pays for a part of your drug costs. 
• Part D generally protects you against ever having very high drug expenses. 
• Part D pays for brand-name and generic drugs. Starting in 2024, it also covers prenatal vitamins prescribed by a doctor.
• You have to pay premiums, a deductible, and co-payments Money paid for health care in addition to what the insurer pays . But, as noted above, there is Extra Help from the government to pay these costs for certain people with low income.
• You apply for Medicare Part D benefits directly from the insurer of your choice.
• You can choose from a selection of different plans that cover the area where you live. The plans may have different prices and drugs covered. Visit the Medicare website for more information about drug costs. 
• You must join during the enrollment periods.
• You may have to pay a penalty if you don't join Medicare Part D when you are first eligible but join later. 

When can I enroll in a Medicare drug plan?

The open enrollment period for a Medicare Drug Plan is available in these situations:

• The 7-month period that begins 3 months before you turn 65, includes the month of your 65th birthday, and ends 3 months after the month you turn 65.
• If you get Medicare due to a disability A substantial impairment that functionally limits a person in carrying out major life activities, such as walking, lifting, seeing, or learning. , 3 months before to 3 months after your Medicare eligibility date.
• During the annual enrollment period, which is between October 15 – December 7.  Coverage starts the following January 1.
• Anytime, if you qualify for Extra Help.
• January 1 through March 31 of every year if you enroll in a Medicare Advantage Plan.

If you want to join or switch plans, do so as soon as possible. This way, you have your membership card when your coverage begins, and you can get your prescriptions filled without delay.

How do I join a Medicare drug plan?

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 the Medicare website.

You can also register by calling (800) 633-4227 (TTY users 877-486-2048).

Are there other times that I can join, switch, or drop plans?

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 additional prescription drug coverage,
• Live in a nursing home or institution, or
• Are eligible for Extra Help.

Will I be penalized if I don't enroll in Part D right away?

There may be consequences if you don't enroll in Part D when you are first eligible. You'll likely have to pay a higher premium if you decide to join later.

This penalty won't be charged if you had drug coverage from another place, such as an employer. However, the coverage you had must have been as good as a standard Medicare prescription plan. This is called creditable prescription drug coverage.

Even if you dropped or lost that coverage, you can avoid the penalty as long as you haven't been without coverage for more than 63 days in a row. You won't be charged a penalty if you get Extra Help.

The amount of the penalty depends on how long you went without Medicare drug coverage or other similar prescription drug coverage. The penalty is calculated by multiplying 1% of the national average monthly premium by the number of months you weren't covered. That amount is rounded to the nearest $0.10, then added to your monthly premium. You will typically need to pay the penalty every month while you have Medicare drug coverage. Since the national average premium can go up each year, the penalty can also go up every year.

It's important to keep this penalty in mind when deciding whether to enroll in a plan. This is true even if you have low prescription drug costs now. If you wait too long, you'll pay a larger penalty when you need more help with prescription costs.

Where can I get assistance and learn more?

• Medicare website or help hotline at (800) 633-4227 
• Illinois Department on Aging at (800) 252-8966
• The Center for Medicare Advocacy
• Medicare Interactive
• Medicare Rights Center