If you’re new to Medicare, you may be surprised to learn that prescription drug coverage is not automatically guaranteed. As such, there are some different ways that you can get help paying for your prescriptions:
- Purchase a separate Part D prescription drug plan that is supplementary to your original Medicare plan
- Enroll in a Medicare Advantage plan, which rolls up your prescription drug coverage and medical coverage into one single plan
- Check to see if you qualify for a Special Needs Plan (SNP), which includes Part D coverage and allows for changes outside of open enrollment
Because Medicare Advantage plans combine medical and prescription drug coverage, this is one of the reasons that we recommend Medicare Advantage plans to all of our Meadowcrest patients. In this blog, we will explain how the Medicare Part D enrollment period works and what you need to do to enroll or change coverage.
First, let’s review the four different Medicare enrollment periods:
- Initial Enrollment Period (IEP): Applicable to your first time enrolling in Medicare, it runs for three months before and after you turn 65. Note: if you are under 65 but have a disability, you are eligible for Medicare after 24 months of receiving Social Security or Railroad Retirement Board (RRB) disability benefits.
- Medicare Advantage Open Enrollment: Specifically for beneficiaries with a Medicare Advantage plan, this time period lasts from January 1-March 31 each year.
- Special Enrollment Period (SEP): Unique circumstances sometimes occur that trigger a SEP, which means you can change coverage outside of the normal open enrollment periods.
- Medicare Annual Enrollment: Only applicable to those with a Medicare original plan, this occurs each year from October 15-December 7. If you don’t yet have a Medicare Advantage plan, then you can switch during this time period.
With these enrollment periods in mind, let’s explore your options for securing Medicare Advantage Part D coverage.
Adjust Your Medicare Advantage Part D Coverage During Open Enrollment
The 2023 Medicare Part D enrollment period for Medicare Advantage plan holders is open from January 1-March 31, 2023. You must already have a Medicare Advantage plan in order to make coverage changes during this time period. After you have selected a new plan, the coverage changes come into effect on the first day of the following month.
There is an exception to watch out for in this case, which is if the Medicare Advantage plan you selected does not include your prescription drug coverage. This may occur in two scenarios:
- The Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan you switch to does not include your prescriptions. While this usually does not happen, you will need to secure Part D coverage outside of Medicare if it does; you are not permitted to buy a stand-alone Part D plan when you have a Medicare Advantage HMO or PPO plan.
- You have a Medical Savings Account plan or Private Fee for Service plan. In this case, you are permitted to join a separate Part D plan.
Receive Automatic Part D Coverage When You Enroll in a Special Needs Plan
Special Needs Plans are required to include prescription drug coverage, so you won’t have to worry about securing a separate Part D plan if you qualify for an SNP. Those who qualify for a Special Needs Plan are able to make coverage changes outside of the typical Medicare Part D enrollment period. This is because when you qualify for an SNP, it triggers a Special Enrollment Period for you to adjust your plan to fit your needs.
An SNP is a unique Medicare Advantage plan that is available for patients who have certain medical conditions, advanced caretaking needs, or income limitations.
In order to enroll in an SNP, check the eligibility requirements to see if you qualify:
- Chronic Condition SNP (C-SNPs): This SNP is reserved for patients who have one or more chronic conditions that are severe or disabling. The list includes cancer, certain cardiovascular diseases, dementia, diabetes, end-of-stage liver or renal disease, HIV/AIDS, certain disabling mental health conditions, and many others. We are happy to review your medical history with you to check whether you qualify for a C-SNP.
- Institutional (I-SNPs): These SNPs are available for patients who have advanced caretaking needs for at least 90 days, whether they receive those services at home or reside in a facility like a nursing home, rehabilitation facility, or psychiatric hospital.
- Dual Eligible SNP (D-SNPs): These SNPs are for people whose income qualifies them to receive both Medicare and Medicaid benefits.
There are other life circumstances that trigger a Special Enrollment Period, such as if you move residences or lose coverage. For full details, visit the Medicare SEP page.
Make an Appointment with our In-Office Representative
We know that every patient has unique medical and prescription drug coverage needs, and we are committed to helping you find the best available plan. Please contact us to schedule an appointment with our in-office rep to explore your available options.