For those living in Connecticut and getting ready to apply to Medicare, there are some essential things you need to know. For example, did you know that Original Medicare Parts A and B do not cover prescription drugs? If you need to take medication for health conditions such as high cholesterol, diabetes, or heart issues, these medications are not covered under Part A or Part B. That’s why you need to get prescription drug coverage separately.
Medicare Part D Prescription Drug Plans
In the state of Connecticut, as with all states, if you’re 65 or older, you’ll be eligible to enroll in Medicare. This means that you’ll be able to choose between staying with Original Medicare or enrolling in a Part C Medicare Advantage plan. If you stay with Original Medicare, you’ll also need to enroll in a stand-alone Part D plan for prescription medication. Why? Because Medicare Part A will only cover medications that are part of inpatient hospitalization, and Part B only covers certain drugs given to you during outpatient treatment, such as injections.
If you want prescription medication to be included under your health coverage and you only have Original Medicare, you’ll need to purchase a stand-alone Part D plan.
Part D plans are available for those living in Connecticut through private insurance companies approved by Medicare. Each plan has a formulary of the medications they cover and it’s important to read it to find out if your prescriptions are included. While the list can change, the insurance company will notify you if it does. Your insurance will typically cover medications they’ve removed from the list for the remainder of the coverage year.
If you have a Medicare Advantage and need prescription drug coverage, you’ll need to choose a Medicare Advantage plan that includes prescription drug coverage.
Enroll in Medicare Part D in Connecticut
If you are enrolled in Original Medicare Parts A and B, you can enroll in a stand-alone Medicare Part D plan for your prescription medication coverage. If you have Medicare Advantage, you’ll need to opt for a Medicare Advantage drug plan. Keep in mind that if you opt for Original Medicare and a Medigap plan, the Medigap plans do not offer prescription drug coverage. You’ll still need to choose a stand-alone Part D plan.
To enroll in a Part D plan in Connecticut, you’ll have specific times for enrollment. The first option available is your Initial Enrollment Period or IEP. This period is when you first become eligible to enroll in Medicare, and it starts three months before your 65th birthday, the month you turn 65, and three months afterward.
If you are qualified to enroll in Medicare due to a disability, your IEP starts the 22nd month after receiving Social Security benefits, the 25th month, and continues through the 28th month.
Should You Get Prescription Drug Coverage?
While it is true that prescription drug coverage is optional, if you don’t sign up for it during your Initial Enrollment Period and decide to enroll later, you may pay a late penalty for the life of your policy.
In addition to your IEP, there are three other times when you can sign up for a prescription drug plan.
First, you can enroll during the Annual Election Period that runs from October 15 through December 7 if you’re enrolling for the first time. During this time, you can also change plans from Original Medicare to Medicare Advantage or vice versa. If you already have Medicare Advantage and want to change from one Medicare Advantage Prescription Drug plan to another or switch from Medicare Advantage back to Original Medicare, you can do so during your Medicare Advantage Open Enrollment Period, which lasts from January 1 through March 31.
Finally, if you encounter a life changing event such as moving out of your insurance’s service area, or losing Medicaid coverage, you can enroll when these changes occur. This is known as your Special Election Period.
Depending on your location and service area, Medicare Part D plans for prescribed medications and Medicare Advantage plans for drug coverage will offer different prescription coverage and come with varying monthly premiums. Spend some time researching the benefits available in each plan and the costs for options in your service area. Make sure that it includes your medication before choosing a plan. Even if you are not currently taking prescribed medications, signing up now will enable you to avoid late fees and keep you covered when you need it.
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