Medicare Part D Plans in Massachusetts
If you’re planning to enroll in either Original Medicare or a Medicare Advantage plan, you can also get prescription drug coverage through Medicare Part D. Prescription drug coverage in Massachusetts is available to Medicare beneficiaries in two ways:
- Add a standalone Part D plan to either Original Medicare or a Medicare Advantage (MA) plan that does not include prescription drug coverage
- Sign up for a Medicare Advantage Prescription Drug plan (MA-PD)
What Is Medicare Part D in Massachusetts?
Medicare Part D is how Medicare beneficiaries get prescription drug coverage, something not included with Original Medicare. The plans – whether standalone or as part of a Medicare Advantage plan – are sold by private insurance companies that contract with Medicare to provide these benefits.
Although most MA plans include prescription drug coverage, not all of them do. If you want an all-in-one plan, look for the MA-PD designation that indicates prescription drug coverage.
Medicare Part D Requirements in Massachusetts
If you are eligible for Original Medicare AND enrolled in Part A (hospital insurance) and/or Part B (medical insurance), you qualify for Medicare Part D coverage in Massachusetts.
In addition to qualifying for Medicare, you must also meet the guidelines set forth by the plan. Typically, this means living within the Part D plan's service area.
When Can You Join a Medicare Part D Plan in Massachusetts?
The Medicare program restricts enrollment to certain periods.
Your Initial Enrollment Period (IEP) coincides with when you first become eligible for Medicare. If you qualify based on age, your IEP begins 3 months before the month you turn 65. It extends through your birth month and the 3 following months to give you a full 7 months to sign up for Medicare. Unless you began receiving Social Security benefits at least 4 months before turning 65, Medicare enrollment is not automatic. And enrollment in Medicare Part D is never automatic. You must sign up for a Part D plan unless you have creditable coverage elsewhere. ("Creditable" means coverage that is equal to or better than Medicare in terms of both coverage and costs.)
If you qualify for Medicare due to disability, you will be automatically enrolled in Parts A and B on the 25th month of receiving Social Security disability benefits. You also get a 7-month IEP. It begins on your 22nd month of receiving disability benefits and extends through month 28. During this period, you may sign up for a standalone prescription drug plan or an Advantage plan (with or without prescription drug coverage).
If you sign up during the Part B General Enrollment Period (January 1 through March 31), you can enroll in a Part D plan from April 1 through June 30.
The Medicare Annual Enrollment Period (AEP) occurs every year from October 15 through December 7. Current Medicare enrollees may sign up for a Part D plan during AEP.
If you're enrolled in an Advantage plan, you can participate in Medicare Advantage Open Enrollment from January 1 through March 31. However, you may only sign up for a Part D plan during this time if the changes you make during Open Enrollment end in you losing your prescription drug coverage.
Finally, if you qualify for a Special Enrollment Period (SEP), you may be able to buy either a standalone Part D plan or Medicare Advantage Prescription Drug plan. Click here to see the full list of qualifying special circumstances is on Medicare.gov.
What to Look for in a Medicare Part D Plan in Massachusetts
When comparing Medicare Part D plans in Massachusetts, you need to consider both coverage and costs.
Coverage starts with the drug formulary. This is the list of prescription medications that the plan covers. If your prescriptions aren't on it, look for a different plan.
Part D plans also include restrictions. These vary by plan but all of them include drug tiers. To estimate your prescription copays, see which tiers your medications are on. The lower the tier, the lower your out-of-pocket cost.
Next, you want to look at the full cost of the plan. Your out-of-pocket costs under Medicare Part D include:
- Monthly premium
- Annual deductible
- Copays and/or coinsurance
You should look at the full cost of the plan, not just the monthly premium. This includes tiered pricing as well as the deductible and copays. If you have limited income and resources, you may qualify for Extra Help. This program helps Medicare beneficiaries pay a variety of Part D costs.
What Happens if You Don't Enroll in Medicare Part D in Massachusetts?
If you delay Medicare Part D enrollment AND do not have creditable prescription drug coverage elsewhere, you face lifelong late enrollment penalties. You start earning the late fee any time you go 63 consecutive days without prescription drug coverage. The late fee is added to your monthly premium for the entire time you have Medicare Part D coverage.