Medicare Part D FAQ
What is Medicare?
Medicare is the federal health insurance program for adults who are 65 and older and people with a qualifying disability. It's broken down into four parts:
Part A: Hospital insurance
- Hospital care
- At-home nursing / nursing facility care
Part B: Medical insurance
- Doctor's office visits / preventative care services
- Medical items (diabetes testing supplies, home medical equipment, nebulizers)
- Mental health services
Part C: Also known as Medicare Advantage or MA-PD
- Combination of Parts A & B (plus prescription drug coverage)
- Vision, dental & hearing1
- Non-medically necessary services1
- Medical savings account plans1
Part D: Prescription Drug Plan
Frequently asked Medicare Part D questions
Q: What are the benefits of Medicare Part D?
A: If you've been paying cash for your prescriptions, Medicare Part D will save you money. Each provider's plan must be approved by Medicare, which means you have the security of reliable prescription insurance, no matter which plan you choose.
Q: What if I cannot afford insurance?
A: If you're worried you will not be able to afford a Medicare Part D drug plan, you may qualify for extra help. Contact your local Social Security Administration office for details, visit the agency online at www.ssa.gov/prescriptionhelp or call 1-800-772-1213. You may also qualify for other drug discount programs. Talk to your Walgreens pharmacist for more information.
Q: Is enrollment voluntary?
A: Yes. However, the longer you wait to sign up, the higher your premium will be. If you don't sign up for a Medicare Part D plan when you are first eligible, you will pay a 1% penalty per month-up to a 12% penalty for each year-you wait before signing up. So if you think you might need Medicare Part D later, you could save by signing up now. (If you are currently covered by a prescription drug plan through your employer, this may not apply to you.)
Q: What if I want to switch plans after enrolling?
A: No problem. Every year there will be an open enrollment period. Open enrollment is October 15 through December 7. You may change Medicare Part D plans at that time.
Q: Where can I get my prescriptions filled?
A: At any pharmacy within your network. Most Medicare Part D plans will charge the same co-pay, as long as you go to a network pharmacy. Each network will have several pharmacy options, so you can go to a pharmacy that offers the services and convenience that best meet your healthcare needs. You'll get all of that at Walgreens.
Q: Why is there a late enrollment fee?
A: Congress believes that unless you already have creditable prescription drug coverage, Medicare Part D plans are a great way to help you with the cost of prescription drugs. They crafted the rules to encourage people to enroll in the beginning instead of waiting to join only when health problems develop and drug costs rise. The late enrollment fee gives people a reason not to postpone the decision to join.
Q: Who is eligible for Medicare Part D prescription drug coverage?
A: All individuals with Medicare Part A or Medicare Part B are eligible to enroll regardless of age, income or health conditions.
Q: How do I know if I should sign up?
A: You will need to review your options carefully to see if a Medicare Part D plan is right for you. Part D plans are designed to provide financial savings to most people with Medicare. As insurance plans, they provide protection against future, unexpected costs. They also provide additional financial assistance for people with lower incomes.
Q: How do I find out if I qualify for help?
A: If you have both Medicare and Medicaid, you already qualify for low-income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance. In some cases, the government will also review the value of the assets you own. If you think you might qualify, contact your local Social Security Administration office. You have nothing to lose by applying.
Q: What assets will be counted to determine if I am eligible for help?
A: The assets that will be counted include cash or any property that can be converted to cash within 20 days. This includes checking accounts, savings accounts, certificates of deposit, retirement accounts (like IRAs or 401ks), stocks, bonds, mutual fund shares, promissory notes and mortgages. Property that is not counted includes your life insurance policies, primary home, burial plots or burial agreements. Certain funds set aside for burial expenses, up to $1,500, will also not be counted.
Q: Can I change Medicare Part D plans once I have enrolled?
A: Yes, you can change your Part D plan. The opportunities to switch are:
Annual enrollment: Each year, you will be able to choose a different Medicare Part D prescription drug plan or Medicare Advantage plan during an annual enrollment period. The enrollment period is October 15 through December 7. Coverage under the new plan will begin the following January 1.
Other exceptions: There are other limited exceptions that may give you the right to switch plans during a year. For example, if you move out of the service area of your current plan, you will have an opportunity to choose another plan that serves your new area.
Q: How will I know if the drugs I currently take will be covered?
A: Each Medicare Part D plan will provide its own formulary or list of covered drugs. This information will be available through the plan's web site, customer service center and through marketing materials. You can also find information online at Medicare.gov
Q: Who decides which drugs will be covered on a formulary?
A: All Part D plans must meet formulary requirements set by Medicare. The formulary will include both generic and brand name drugs. Each plan must use a Pharmacy and Therapeutic Committee, which includes doctors and pharmacists, to establish its formulary. This process assures you access to a number of drugs, although not necessarily all drugs.
Q: Which drugs are excluded from Medicare Part D plans?
A: The drugs excluded from Part D by Medicare are:
Drugs used for anorexia, weight loss, or weight gain
Drugs used to promote fertility
Drugs used for cosmetic purposes or hair growth
Drugs used for the symptomatic relief of cough and colds
Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
Barbiturates (sleeping pills)
Benzodiazepines (central nervous system depressants)
In addition, a drug cannot be covered under a Medicare Part D plan if payment for that drug is available under Parts A or B of Medicare, such as drugs administered in a hospital or a physician's office. Also, each Part D prescription drug plan may have its own specific exclusions.
Q: Will Medicare Part D cover drugs purchased from Canada?
A: No. Only drugs sold in the United States are eligible for Part D coverage.
Q: Can premiums be deducted from Social Security checks?
A: Yes, you will have the option to have the premium deducted from your Social Security check (just like your Medicare Part B premium). If applicable, you or your former employer can pay your premium directly to the private company.
Q: What is creditable coverage?
A: Creditable coverage is coverage from a plan other than a Medicare Part D plan that meets certain Medicare standards. If you currently have prescription drug coverage that is considered creditable coverage, you may keep that coverage and wait to enroll in a Part D plan. If you later decide to enroll in a Part D plan, you will not have to pay a late enrollment fee.
Q: Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?
A: No, Part D coverage will not be available directly from Medicare. Although you will be able to have your premium deducted from your Social Security check, you must purchase Part D coverage from a private company that has been approved by Medicare to offer coverage.
Q: I have drug coverage through the Veterans' Administration (VA). Can I continue to get my prescriptions through the VA?
A: Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their prescriptions through the VA.
Q: If I live in the U.S. territories, will I have access to a Medicare Part D plan?
A: Yes, Medicare Part D plans will be available in the U.S. territories.
Q: I take several different prescription drugs. Will there be help with managing all my medications?
A: Yes, one of the advantages of Medicare Part D plans is that there will be help managing drugs for people who take multiple medications, have chronic diseases, such as diabetes or heart disease and high drug costs. The help is designed to make sure that your medications work well together and reduces the risk of a bad reaction. You might also hear this called medication therapy management.
Frequently asked Prescription Drug Plan questions
Q: Which plan should I pick?
A: Based on your specific drugs, Walgreens can help you navigate Medicare enrollment with education and cost information about different Medicare Part D and Medicare Advantage options in your area.2 It's important to review medical, financial, and other important considerations when selecting a plan. We can't make specific plan recommendations but you can go to Medicare.gov, a licensed agent, or carrier to determine which plan is best for you.
Q: Do I need to enroll or re-enroll in a plan?
A: If you're eligible but do not enroll in a Medicare Advantage or Medicare Part D plan during open enrollment, you may not be able to apply for or receive Medicare coverage for the upcoming year. To determine if you are eligible for special circumstances, visit Medicare.gov or a carrier for more information.
If you're already on a Medicare Advantage or Medicare Part D plan eligible for renewal, most plans renew your enrollment automatically. Contact your plan carrier or a licensed agent to confirm this is the case. Your carrier will send you an ANOC (Annual Notice of Change) which outlines all the changes to your plan for the next year, including whether your plan is discontinued or has changed substantially enough to require you to submit a new request for coverage. Contact your plan carrier if you have any questions.
If you are on a Medicare Advantage or Medicare Part D plan which was discontinued, you may be required to re-enroll during open enrollment or you may not have prescription drug coverage through Medicare for calendar year 2015. Contact your plan carrier or a licensed agent to determine whether or not you need to re-enroll.
If you have healthcare coverage through an employer or another source and you are eligible for Medicare, contact your plan or carrier to determine if you're required to enroll in Medicare Part D to avoid a delayed enrollment penalty.
Q: Why do co-pays vary across the different "tiers"?
A: Drugs are grouped into different tiers by each carrier and plan. The tiers may be based on whether a drug is generic or branded and other factors. Your local Walgreens pharmacist can work with you to see if there are drug alternatives that will lower your co-pay.
Q: What is included in the "Estimated Annual Costs"?
A: The "Estimated Annual Costs" value represents an estimated total out-of-pocket cost you would pay for that specific plan. The value is calculated by adding the annual deductible, the monthly premium (multiplied by 12 months), and the total estimated drug-specific co-pay or co-insurance costs (based on your current medications covered by the plan).
1 Specific coverage available only under some plans. Source: http://www.medicare.gov/what-medicare-covers/index.html
2 Walgreens is a Pharmacy and our Pharmacists are healthcare professionals, not licensed insurance agents, and do not make specific plan recommendations. We encourage all Medicare patients to consider medical, financial, and other important considerations when selecting a plan. Go to Medicare.gov or a licensed agent for more information.