Prescription coverage for those enrolled in Medicare in Delaware is available through the Medicare Part D plan options. Medicare Part D plans in Delaware, like other states, are provided by private insurance companies accredited by Medicare. To date, more than 222,000 people are living in Delaware who are enrolled in Medicare, and around 75% of them are enrolled in Part D prescription drug plans, according to the Centers for Medicare and Medicaid Services (CMS).
What will Medicare Part D cost in Delaware?
Medicare Part D plans are sold by private insurance companies, so costs and coverage vary. However, you can expect a monthly premium, copays or coinsurance due at the time of service, and a yearly deductible, which is the out-of-pocket costs you pay before your insurance starts to cover your prescriptions. Copayments depend on what tier the insurance company places your prescription medications. Generic drugs, for example, are usually placed in Tier 1 and have a lower copay. Specialized drugs with no generic option are in Tier 5 and will have a higher copay.
Why do you need Medicare Part D?
When you enroll in Original Medicare, you’re only getting insurance to cover fees associated with hospital (Part A) and doctor visits (Part B). Prescription drugs, however, aren’t part of that coverage. Medications you need regularly could cost hundreds to thousands of dollars out-of-pocket. This is why it’s a good idea to seriously consider adding Medicare Part D prescription drug coverage to your healthcare.
There are two ways you can get prescription drug coverage. First, you can get it as a stand-alone plan known as Part D, along with your Part A and B Original Medicare coverage. Stand-alone plans only work with Original Medicare.
A second option for obtaining prescription drug coverage is through a Medicare Advantage Prescription Drug plan. When you have an all-in-one Medicare Advantage Prescription Drug plan, your Medicare Part A, B, and D benefits will all be included in one plan. If you choose a Medicare Advantage plan, you cannot purchase a stand-alone drug plan like you do if you only have Original Medicare. The majority of Medicare Advantage plans in Delaware offer prescription drug coverage as part of their plans.
The advantage of opting for a Medicare Advantage plan is that your prescription drug plan is often included, and the premium can be as low as $0 per month. You will still pay the Medicare Part B premium, and you’ll likely have a deductible for your drug plan, but if there is no deductible, you’ll save on that cost.
Enrolling in Medicare Part D in Delaware
To enroll in Medicare Part D in Delaware, you will need to:
- Enroll in Original Medicare Part A and/or B, and
- Live in the service area of a Medicare plan that offers prescription drug coverage.
As with other parts of Medicare, you can only sign up for or change the coverage of your Medicare prescription drug plan during certain periods. These timeframes include:
- Initial Enrollment Period: This is a seven-month period when you are eligible for the first time to register for Part D of Medicare. If you age-in to Medicare, this period will begin three months before you are 65 years old, include the month you are 65 years old and continue for three months afterward. If you qualify for Medicare due to a disability, your enrollment period will start three months before the 25th month of disability benefits, include the twenty-fifth month, and continue afterward for three months.
- Annual Election Period: This is also called Open Enrollment Period for Medicare Advantage and Medicare Prescription Drug Coverage and it goes from October 15 to December 7. During this time, you can sign up for the first time, change from Original Medicare to Medicare Advantage, or switch back to Original Medicare and purchase a stand-alone Part D plan.
- Medicare Advantage Open Enrollment: This is the time when you can change Medicare Advantage plans or decide to enroll back into Original Medicare and opt for a stand-alone prescription drug plan. It goes from January 1 through March 31.
- Special Enrollment Period: In addition to the periods mentioned above, you may only amend your choice of coverage if you qualify for a Special Enrollment Period. Circumstances that could provide you with a Special Enrollment Period include moving to a different service area or losing your Medicaid eligibility.
Other Medicare Part D facts
Although Medicare Part D is offered by private insurance companies in Delaware, it is regulated by Medicare. Medicare has defined the main categories of medications that Medicare will provide coverage for, including:
- HIV/AIDS treatment
- Anticonvulsive treatment for seizures
- Immunosuppressant drugs
- Anticancer medications not covered by Medicare Part B
Each plan includes a list or formulary that identifies all the medications it covers. The formulary can change at any time during the year, but you will be notified when necessary. Drugs in the formularies are divided into cost tiers. Tier 1 generally includes generic drugs and is the least expensive. Tier 5, on the other hand, includes specialty drugs that have no generic options and is the most expensive tier. Be sure to shop around and compare plans to ensure it includes the medication you need in addition to checking the prices for drugs, copays, deductibles, and coinsurance you might be responsible to pay.
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