Could you benefit from prescription drug coverage if you live in Iowa? If you take prescription medications now or expect to at any time in the future, then the answer is probably yes and you'll want to learn more about Medicare Part D.
How many people in Iowa have Medicare Part D?
You might be surprised to know that, according to the Kaiser Family Foundation (KFF), over 646,000 Iowa residents are enrolled in Medicare. Of those, over 535,000 are enrolled in a prescription drug plan, but CMS found that 75% of them could still do better and find a Part D plan with lower out-of-pocket costs.
If you're reading this, chances are high that you could also benefit from enrolling in Medicare Part D coverage in Iowa. Here is everything you need to know.
What is Part D Medicare in Iowa?
Private insurance companies provide Medicare Part D plans in Iowa, just as they do in every other state. These insurers have contracted with Medicare to provide these benefits.
There are two different ways to obtain Part D coverage in Iowa:
- A Medicare Advantage Prescription Drug plan (MA-PD) offers the same benefits as Original Medicare plus a standalone Part D plan. Please note that, even if your Advantage plan charges a monthly premium, you'll still have to pay your Medicare Part B premium.
- You can add a standalone Medicare Part D plan to either Original Medicare or an Advantage plan that does not include prescription drug coverage.
You cannot enroll in both a Medicare Advantage Prescription Drug plan and a Medicare Part D standalone plan at the same time. If you try, you will be unenrolled from your MA plan and placed back into Original Medicare.
Why would you need Medicare Part D in Iowa?
Original Medicare does not cover prescription medications. The only drug coverage you get through Part A or Part B is if you need provider-administered drugs, such as injections given by a nurse or physician. Self-administered medications are covered by either Medicare Part D or an MA-PD plan.
You also face significant late fees if you delay Part D enrollment without having creditable prescription drug coverage elsewhere. (Creditable means coverage that is equivalent to Medicare in terms of both cost and benefits). When you do finally enroll in a Medicare Part D plan, you will pay these late penalties for the entire time you have Medicare.
How do you qualify for Medicare Part D in Iowa?
To qualify for a Medicare Part D plan, you must meet both of the following guidelines:
1. Be enrolled in Medicare Parts A and/or B and
2. Live in the Part D plan's service area
What to look for in a Medicare Part D plan in Iowa
Each prescription drug plan will cover different needs and it’s important that you assess which plan is right for you. The main items you need to consider are the drug formulary and your out-of-pocket costs under the plan.
Every Part D plan has a list of drugs that it covers. This list is called a formulary. Drug formularies can change at any time. If your formulary changes, the insurance company will notify you.
If the formulary change impacts one of your prescriptions, your plan will usually give you another 30-day supply of your medication. Exceptions include if the Food and Drug Administration (FDA) considers the drug unsafe or the drug's manufacturer withdraws it from the market. In these instances, a generic option should be available. If comparable medications are not effective, your doctor can help you file an exception request. You can then change to a new Part D plan during Annual Enrollment (see the next section).
Most Part D plans also use tiered pricing, with drugs on the first tier being the least expensive and those on the top tier costing the most. The number of tiers varies according the plan, but 4- and 5-tier plans are the most common.
When can I sign ip for a Medicare Part D plan in Iowa?
There are specific periods when you can sign up for a Medicare Part D plan in Iowa, starting with your Initial Enrollment Period (IEP).
Your IEP lasts for 7 full months. It begins 3 months before your 65th birthday and ends 3 months after your birth month. If you sign up for Medicare during your IEP, you can also enroll in a Part D prescription drug plan. Enrolling in Part D during your IEP ensures you don't face lifelong late enrollment penalties.
You may also sign up for or change to a new Medicare Part D plan during the Annual Enrollment Period (AEP). Annual Enrollment is available to everyone currently enrolled in Medicare. It occurs every year from October 15 through December 7.
During AEP, you may:
- Leave Original Medicare for an Advantage plan
- Switch from one MA plan to another
- Leave a Medicare Advantage plan to return to Original Medicare
- Enroll in a Medicare Part D plan
- Switch from one Part D plan to another
You may also be able to sign up for a new Part D plan during the Medicare Advantage Open Enrollment Period (OEP). Open Enrollment occurs every year from January 1 until March 31, but it is only available to people who are enrolled in an MA plan. During OEP, you may switch from one MA plan to another or leave your Advantage plan to return to Original Medicare. If the change you make leaves you without prescription drug coverage, you may also enroll in a standalone Part D plan.
You may also qualify for a Special Enrollment Period (SEP) if you meet certain criteria, such as moving or losing your current coverage. Review the full list of special circumstances that qualify you for an SEP by clicking here.
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