If you're enrolled in Medicare, Part D provides important coverage to help Indiana residents cover the cost of their prescription medications. And enrolling when you first become eligible can save you from paying lifelong late fees. Original Medicare (Part A, hospital insurance, and Part B, medical insurance) does not include prescription drug coverage. While it allows for severely limited coverage for prescription medications, this only applies to provider-administered medications, such as injections. Medications necessary for chronic conditions like heart disease, cholesterol, or high blood pressure are not covered by Original Medicare. That is why it's essential to purchase a standalone prescription drug plan to work in conjunction with your Part A and Part B coverage.
Medicare Advantage prescription drug plans in Indiana
If you prefer an all-in-one plan, you can sign up for a Medicare Advantage Prescription Drug plan (MA-PD).
Also known as Medicare Part C, Advantage plans provide the same benefits as Original Medicare. In addition, many MA plans offer extra benefits. The most common are:
- Prescription drug coverage
- Routine vision care
- Routine dental care
- Hearing aids
- Fitness programs
Not every Medicare Advantage plan includes prescription medications, so look at the plan's benefits when comparing your options. If the MA plan you prefer does not include prescription drug coverage, you can always enroll in a standalone Part D plan.
All Part D and Medicare Advantage plans – with or without prescription drug coverage – are provided by private insurance companies that contract with Medicare to provide said coverage.
Please note that you cannot enroll in a standalone Medicare Part D plan if you're already enrolled in an MA-PD plan. If you do, you will be disenrolled from your Advantage plan and returned to Original Medicare.
Medicare Part D enrollment in Indiana
As with other parts of Medicare, there are rules when it comes to registering for Part D coverage. You are eligible for Medicare Part D when you have Medicare Part A and/or B and live in the Part D plan's service area. To be eligible for Medicare Part A or Part B, you must be a U.S. citizen or a permanent resident for a minimum of 5 consecutive years.
When can you enroll in Medicare Part D?
There are specific times when you can register for Medicare Part D coverage in Indiana.
Initial Enrollment Period (IEP): This is the period when you first qualify for Medicare coverage. Your Initial Enrollment Period begins 3 months before your 65th birthday. It extends through the month of your birthday and lasts for 3 months after you turn 65.
If you receive Medicare due to a disability, you qualify for Medicare beginning with your 25th month of collecting Social Security disability benefits. Enrollment in Parts A and B is automatic. However, you also get a 7-month IEP that allows you to choose a Part D or Medicare Advantage plan. Your IEP starts 3 months your 25th month of collecting disability benefits and ends 3 months after.
Annual Enrollment Period (AEP): This period runs from October 15 to December 7 each year and is available to everyone currently enrolled in Medicare. During AEP, you can:
- Leave Original Medicare to enroll in a Medicare Advantage plan
- Change from one MA plan to another
- Sign up for a new Medicare Part D plan
- Leave your Advantage plan to return to Original Medicare
Changes you make during Annual Enrollment take place on January 1.
Medicare Advantage Open Enrollment Period (OEP): From January 1 to March 31, people currently enrolled in a Medicare Advantage plan may change to a new MA plan or switch back to Original Medicare. If the changes you make during this period leave you without prescription drug coverage, you may also enroll in a Medicare Part D plan.
Special Enrollment Period (SEP): Special circumstances, like moving or losing your current coverage, may qualify you for a Special Enrollment Period. There are many ways to qualify for an SEP. You can find the full list on Medicare.gov here.
Picking Medicare Part D coverage in Indiana
All Medicare plans in Indiana, which includes prescription drug coverage, will vary concerning the medication and pricing. Before signing up for a standalone Medicare Part D plan or a Medicare Advantage Drug Plan, make sure that the medications you take are included in the plan’s formulary. Formularies are lists of drugs that a prescription drug plan will cover. If you don't see your prescriptions listed in the formulary, choose a different plan.
You’ll also see that the plan places covered drugs on certain tiers, which indicates how much you'll pay for the medication. Tier 1 drugs are typically generic and cost less. As you go up the tiers, the medications become more expensive. This is important to note when comparing costs of different plans. The formularies can change from year to year, but if this occurs, your plan will notify you.
Another factor to consider is that Medicare Part D plan costs will also vary. Your out-of-pocket costs include:
- Monthly premium
- Yearly deductible
- Copays and/or coinsurance
When comparing your Part D plan options in Indiana, look at the full cost – not just the monthly premium. And again, be sure that your medications are on the list.
If you aren't currently taking prescription medication, it's still a good idea to enroll in Medicare Part D. Enrolling on time will not only save you a late enrollment fee, but it will cover you when you do need prescription medication in the future.
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