For anyone who wants Medicare prescription drug coverage in Kentucky, there is more than one option available. An especially important part of the process is understanding how to obtain prescription drug coverage and deciding whether you want your Medicare Part D benefits through a standalone plan or a Medicare Advantage Prescription Drug plan.
Does Original Medicare include prescription drug coverage?
Original Medicare (Part A, hospital insurance, and Part B, medical insurance) does not cover prescription medications unless they are administered by a healthcare provider, such as injections or infusions. Coverage for self-administered medications, such as those used to manage conditions like high blood pressure or diabetes, is through Medicare Part D.
What are Medicare Part D options in Kentucky?
In Kentucky (and the rest of the United States), you have two ways to get prescription drug coverage:
- A standalone Medicare Part D plan
- A Medicare Advantage Prescription Drug (MA-PD) plan
You may add a standalone Part D prescription drug plan to either Original Medicare or a Advantage plan that does not cover prescriptions.
Medicare Advantage plans offer all the same benefits as Original Medicare, but most (over 90 percent) provide additional benefits as well. Common added benefits include:
- Prescription drug coverage
- Routine vision care
- Routine dental care
- Hearing aids
- Fitness programs
Not all MA plans include prescription drug coverage, so compare your options carefully.
Enrolling in a Part D prescription drug plan in Kentucky
As with other parts of Medicare, there are specific rules regarding when you are allowed to sign up for a Medicare Part D plan in Kentucky.
You first qualify for Medicare Part D coverage when:
- You have Medicare Part A and/or Part B and
- You live in the service area of a Medicare plan that offers prescription drug coverage
Most people become eligible for Medicare Part D at the same time they become eligible for Medicare as a whole – when they turn 65. This is known as your Initial Enrollment Period (IEP). It lasts for a full 7 months, beginning 3 months before the month you turn 65 and ending 3 months after your birth month. Unless you began receiving Social Security benefits at least 4 months before your 65th birthday, Medicare enrollment is not automatic.
People who receive Railroad Retirement Board (RRB) or Social Security disability benefits qualify for Medicare at their 25th month of receiving these benefits. In this case, enrollment in Medicare Parts A and B is automatic. Part D enrollment, however, is not automatic. That's why you also get a 7-month IEP when you qualify for Medicare due to disability. It begins in your 22nd month of receiving disability benefits and ends after your 28th month. Once you enroll in Medicare, you may take advantage of the Annual Enrollment Period (AEP), which occurs every year from October 15 through December 7. During this time, you can:
- Enroll in a standalone Medicare Prescription Drug plan for the first time
- Change to a new standalone prescription drug plan
- Leave your Medicare Advantage plan and return to Original Medicare
- Switch from Original Medicare to Medicare Advantage plan
- Unenroll from your Prescription Drug Plan
Next is the Medicare Advantage Open Enrollment Period (OEP), which occurs every year from January 1 through March 31. You may only participate in Open Enrollment if you are already enrolled in an Advantage plan. Changes you can make during this time are changing to a new Medicare Advantage plan or returning to Original Medicare. If you lose your prescription drug coverage as a result of making one of these changes, you may also enroll in a Medicare Part D plan.
Finally, if you qualify for a Special Enrollment Period (SEP), you may sign up for either a standalone Part D plan or an MA-PD plan. Common circumstances that qualify you for an SEP include moving and losing your current coverage. Find the full list of special circumstances on the Medicare.gov site here.
Why choose Medicare prescription drug coverage in Kentucky?
Even if you do not take prescription medications currently, it’s a good idea to enroll in Part D coverage. If you delay Part D enrollment and do not have creditable prescription drug coverage elsewhere, you face late penalties when you finally do sign up for a Part D plan. You will pay this penalty for the entire time you have Medicare prescription drug coverage. ("Creditable" means a plan that's as good as Medicare in terms of both costs and coverage.)
How to compare Medicare Part D plans in Kentucky
When comparing your Medicare Part D options in Kentucky, you need to look at costs as well as coverage. That's because, no matter how low the monthly premium is, a plan that doesn't cover your medications is not the best plan for you.
Start by looking at the plan's drug formulary. This is the list of covered prescription medications. You also want to look at the drug plan's tiered pricing. All Part D plans use a tiered system, where the least expensive drugs are on the lower tiers and the most expensive medications are on the top tiers. Even if your medications are on the formulary, if one or more of them is on a top tier, you face higher out-of-pocket costs.
As for costs, you need to look beyond the monthly premium to see the full cost of the plan. This includes the yearly deductible and your copays. A rock bottom premium can hide higher out-of-pocket costs. If you have limited income or resources, you may qualify for Extra Help. This Medicare program helps beneficiaries pay some or all of their out-of-pocket prescription drug costs.
Finally, look at the plan's pharmacy network. If none of the preferred pharmacies are convenient for you, check whether the plan allows mail order. With just a little homework, you can find the best Medicare Part D plan available in Kentucky.