If you live in Maryland, you might be surprised to know that there are over 1 million Medicare beneficiaries in Maryland. According to the Centers for Medicare & Medicaid Services (CMS), around two-thirds of them have Medicare Part D coverage.
Medicare Part D in Maryland explained
Medicare Part D in Maryland provides prescription drug coverage for Medicare beneficiaries. Although the coverage is optional, it is highly recommended. If you delay Part D enrollment, you face lifelong late penalties when you finally sign up for prescription drug coverage.
You can get prescription drug coverage in Maryland in two ways:
- Sign up for a standalone Medicare Part D prescription drug plan. This option works if you have Original Medicare (Part A, hospital insurance, and Part B, medical insurance) or a Medicare Advantage (MA) plan that does not include prescription drug coverage.
- Sign up for a Medicare Advantage Prescription Drug plan (MA-PD). Also known as an all-in-one plan, this option gives you the same coverage you'd have with Original Medicare plus a Part D plan.
All Medicare Advantage plans must offer the same benefits as Original Medicare. However, most also provide additional benefits. In addition to prescription drug coverage, this may include routine vision and dental care, hearing aids, and fitness programs.
- Private insurance companies contract with Medicare to provide this coverage. Plans may vary in deductibles, premiums, copays, and other costs and expenses.
- You must live in the plan’s service area.
- Attempting to sign up for a standalone Medicare Part D plan if you're already enrolled in an MA-PD results in you being unenrolled from your Advantage plan and placed back into Original Medicare.
Why do you need Medicare Part D in Maryland?
If you go 63 days or more without creditable prescription drug coverage – either through Medicare or a private insurance plan – you begin incurring late fees. You will pay these penalties for the entire time you have prescription drug coverage through Medicare.
To be considered creditable, a drug plan must offer the same level of benefits that you'd receive from Medicare, at around the same cost. Your plan should send you a notification of creditable coverage. Keep these with your medical records. When you do sign up for a Part D plan, you'll need these notices to avoid paying the Medicare Part D late penalty.
When can you register for Medicare Part D in Maryland?
You have several enrollment periods during which you may sign up for Medicare prescription drug coverage in Maryland.
The first is your Initial Enrollment Period (IEP). This begins 3 months before your 65th birthday and ends 3 months after your birth month. During this 7-month period, you may sign up for Medicare Parts A and B, choose a prescription drug plan, enroll in a Medicare Advantage plan, and sign up for Medigap. Please note that you cannot have both Medigap and an Advantage plan.
If you begin receiving Social Security benefits at least 4 months before your 65th birthday, you will be automatically enrolled in Medicare Parts A and B. However, you must still choose a Part D plan.
People who qualify for Medicare benefits due to disability are automatically enrolled in their 25th month. They also have a 7-month Initial Enrollment Period. It begins in their 22nd month of receiving Social Security disability benefits and extends through month 28. You may enroll in a prescription drug plan during this period.
If you don't sign up for Part B until the General Enrollment Period that runs from January 1 through March 31, you may sign up for a Part D plan from April 1 through June 30.
The Medicare Annual Enrollment Period (AEP) happens every year from October 15 through December 7. During AEP, you may:
- Leave Original Medicare to join an Advantage plan
- Switch from one MA plan to another
- Leave Medicare Advantage to return to Original Medicare
- Sign up for a Part D plan
Changes made during AEP take place on January 1.
The Medicare Advantage Open Enrollment Period (OEP) is available to anyone currently enrolled in an MA plan. It lasts from January 1 through March 31. The only changes you can make during OEP are switching to a new MA plan or moving back to Original Medicare. However, if the changes you make result in you no longer having prescription drug coverage, you may sign up for a standalone Part D plan.
Finally, Special Enrollment Periods (SEP) are available to people who experience certain life changes, such as moving or losing their current coverage. Find the full list of qualifying special circumstances here.
What else should you know about Medicare Part D in Maryland?
For any plan you choose – a stand-alone Part D plan or a Medicare Advantage Prescription Drug plan – you'll want to compare the plans available to you. Prepare a list of prescribed medications you take and compare it to the list of prescriptions the Part D plan covers. These lists, known as formularies, may change, but you'll be notified if a change occurs.
If you have limited income or resources, you may also qualify for Extra Help in Maryland. That link takes you to the Medicare.gov page that describes how to qualify for the program and what level of "help" may be available to you.
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