Health & Benefits

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: 

• Those participating in a Medicare Advantage Plan may also be receiving Part A and Part B coverage in addition to prescription drug coverage. So, signing up for a separate Part D benefit might not be necessary. But if a plan doesn't include prescription coverage, they 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. People receiving any of those three benefits may still qualify for financial assistance to pay for Medicare Part D called “Extra Help.”
• One in three 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 the 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.
• Recipients 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.
• People apply for Medicare Part D benefits directly from the insurer of their choice.
• People can choose from a selection of different plans that cover the area where they live. The plans may have different prices and drugs covered. The Medicare website contains additional information about drug costs.
• People must join during the enrollment periods.
• People may have to pay a penalty if they don't join Medicare Part D when they are first eligible but join later. 

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

• The seven-month period that begins three months before someone turns 65, includes the month of their 65th birthday, and ends three months after the month they turn 65.
• During the annual enrollment period, which is between October 15 – December 7. Coverage starts the following January 1.
• Anytime, if someone qualifies for Extra Help.
• January 1 through March 31 of every year if someone enrolls in a Medicare Advantage Plan.

If someone wants to join or switch plans, it’s important to do so as soon as possible. This way, a membership card can be issued when coverage begins, and prescriptions can get prescriptions filled without delay.

After choosing a Medicare Drug Plan, a person can join by:

• Completing a paper application,
• Calling the plan, or
• Enrolling on the plan’s website or the Medicare website.

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

In most cases, people must stay enrolled for the calendar year, starting the date your coverage begins. However, they can join, switch, or drop plans at other times, if they:

• 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.

A person may have to pay a higher premium if they decide to join Part D later.

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

Even if that coverage stopped, penalties can be avoided as long as a person hasn’t been without coverage for more than 63 days in a row. There is no penalty if someone gets Extra Help.

The amount of the penalty depends on how long a person 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 they weren't covered. That amount is rounded to the nearest $0.10, then added to their monthly premium. They will typically need to pay the penalty every month while they 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 prescription drug costs are lower for someone now. The longer someone waits to enroll in Part D, the larger the penalty when they need more help with prescription costs.

• 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