Medicare beneficiaries can get prescription drug coverage in Maine by signing up for a Medicare Part D plan. Although the Medicare program is over 50 years old, Part D only dates back to 2006. It is the result of the Medicare Modernization Act (MMA) of 2003.
How Can You Get Medicare Part D in Maine?
You have two main options to get Medicare Part D coverage in Maine. The first is by signing up for a standalone Part D prescription drug plan. These are available to anyone who has Medicare Part A and/or Part B. You may also qualify for a Part D plan if you have a Medicare Advantage (MA) plan that does not include prescription drug coverage.
Your second option is to sign up for a Medicare Advantage Prescription Drug (MA-PD) plan. Also known as an all-in-one plan, MA-PDs give you all the same benefits you get with Original Medicare plus a Part D plan. Many plans also offer additional benefits, like routine vision and dental coverage. Compare plans carefully to be sure you're getting the benefits you need at a price you can afford.
Please note that you cannot sign up for both a standalone Part D plan and a Medicare Advantage Prescription Drug plan. If you already have an MA-PD and then enroll in a Part D plan, you will be automatically disenrolled from your Advantage plan and returned to Original Medicare.
Signing Up for Medicare Part D in Maine
To qualify for Medicare Part D in Maine, you must be eligible for Medicare and enrolled in Parts A and/or B.
There are several times that you can enroll in Part D coverage in Maine. These include:
Initial Enrollment Period (IEP): This begins 3 months before you turn 65 and ends 3 months after your birthday, lasting for a full 7 months. If you are not receiving Social Security benefits at least 4 months before your 65th birthday, you must choose to enroll in Medicare. For everyone else, Medicare enrollment is automatic.
During your IEP, you may sign up for Parts A and B as well as a Part D plan, Part C (Medicare Advantage) plan, and/or a Medigap plan. Please note that you may only sign up for Medigap if you have Original Medicare. You cannot pair a Medigap plan with an Advantage plan.
You also qualify for an Initial Enrollment Period if you get Medicare due to a disability. In this case, Medicare enrollment is automatic, starting with your 25th month of collection Social Security disability benefits. Your IEP begins on your 22nd month and extends through your 28th month. You may sign up for a Part D or Advantage plan during this period.
Additional Medicare Part D Enrollment Periods in Maine
The Medicare Annual Enrollment Period (AEP) occurs every year from October 15 through December 7. During this time, you may:
- Leave Original Medicare to join a Medicare Advantage plan
- Switch from one MA plan to another
- Leave an Advantage plan to return to Original Medicare
- Join a Medicare Part D prescription drug plan
Annual Enrollment is available to everyone who is currently enrolled in Medicare.
If you enroll in Part B during the Part B General Enrollment Period, you may sign up for a Part D plan from April 1 through June 30.
The Medicare Advantage Open Enrollment Period (OEP) is available to everyone enrolled in an Advantage plan as of January 1. It lasts through March 31. During this 3-month period, you may switch to a new MA plan or leave Advantage to return to Original Medicare. However, you may only sign up for a Part D plan if the changes you make during OEP result in you losing your prescription drug coverage.
Special Enrollment Periods (SEP) are available to those who experience what Medicare calls special circumstances, such as moving or losing your current coverage. Find the full list of qualifying circumstances here.
Selecting Medicare Part D Coverage in Maine
Whether you choose a standalone Part D plan or Medicare Advantage Prescription Drug plan, you’ll receive coverage through private insurance companies that have contracted with Medicare to provide these benefits. Each plan has different costs and coverage. In addition, plan availability depends on where you live.
Here are some things to remember when looking for Part D coverage in Maine:
- Check the plan’s formulary: Each Medicare plan that includes prescription medications has a formulary or list of medications included in the plan. Formularies vary depending on the plan, so it is important to make sure that your prescription drug plan includes your medications. Formularies can change from year to year, but the insurance plan will notify you if necessary.
- Compare costs: All prescription drug plans will differ in premium, deductible, copay, and coinsurance costs. Each plan also categorizes prescription drugs, according to tiers. Tier 1 drugs are often generic and will cost the least of any tier. Top tiers, on the other hand, are specialty drugs with no generic options and will cost the most. Compare not only what is included in formularies, but how your medications are tiered in various plans to determine the cost to you. Look at the full out-of-pocket costs of the plan, not just the monthly premium.
- Benefits and costs can change every year: Keep in mind that formularies, drug costs, and other benefits may change. It is important to review the coverage every year to ensure that it still meets your needs. If a prescription is removed from the formulary in the middle of a coverage year, your plan must cover at least one more 30-day supply of your medication (unless it has been removed for safety reasons). After that, you and your doctor need to file an exception request. During Annual Enrollment, you may choose a new Part D or MA-PD plan.
- Enroll on time: If you delay Part D enrollment and do not have creditable prescription drug coverage elsewhere, you face significant, lifelong late enrollment penalties when you finally sign up for Medicare Part D in Maine.
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