If you are ready to enroll in Original Medicare (Medicare Parts A and B) or in a Medicare Advantage plan, it is important to make sure you have prescription drug coverage. You can find a Medicare Advantage plan with drug coverage, but if your MA plan does not include it, then you need to sign up for Medicare Part D.
What is Medicare Part D in Massachusetts?
Simply put, Medicare Part D is Medicare's prescription drug coverage. No part of Original Medicare covers prescription medications. Again, though most Medicare Advantage plans include drug coverage, you need to make sure it is a Medicare Advantage Prescription Drug (MA-PD) plan.
Whether you choose a standalone Part D plan or an MA-PD plan, both are offered by private insurance companies contracted with Medicare in Massachusetts.
Medicare Part D requirements in Massachusetts
To qualify for Medicare Part D in Massachusetts you must be eligible for Original Medicare and enrolled in Parts A and/or B. You must also meet any guidelines set forth by a plan, though that usually just means living within the service area.
When can you join a Medicare Part D plan in Massachusetts?
Unless you started to receive Railroad Retirement Board or Social Security benefits at least six months before you turned 65, you must sign up for Medicare, and you will never be automatically enrolled in Part D. Medicare enrollment is restricted to specific periods:
- Initial Enrollment Period (IEP): This period begins three months before the month of your 65th birthday and continues for the three months following. Your IEP is the first time you can sign up for Medicare products.
- Following the General Enrollment Period (GEP): Though you cannot sign up for Medicare part D during the GEP (January 1 through March 31), you can sign up for Part D from April 1 through June 30.
- Annual Enrollment Period (AEP): From October 15 through December 7 every year, current Medicare beneficiaries can enroll in a Part D plan.
- Medicare Advantage Open Enrollment Period (OEP): You can switch between Original Medicare and Medicare Advantage plans during this period (January 1 through March 31), but may only enroll in Part D if any changes you make result in a loss of drug coverage.
Outside of these enrollment periods, you must qualify for a Special Enrollment Period (SEP) to sign up for any Medicare plan. For a list of qualifying circumstances, check here.
What to look for in a Medicare Part D plan in Massachusetts
The two biggest factors in choosing a Medicare Part D plan in Massachusetts are coverage and cost.
Be sure to check any prospective plan's formulary, which is a tiered list of the medications the plan covers. If you can't find your prescriptions on it, then look for a different plan. But also remember that the higher the tier, the higher the cost, so just because a plan's formulary shows your medication doesn't mean another plan won't have it for less.
In addition to your medication co-pays, consider the costs of:
- Annual deductibles
- Monthly premiums
You want to make sure you have all your prescription needs covered, without moving outside your budget. If you find resources are limited, you may qualify for Extra Help, a Medicare program that helps pay for multiple Part D costs.
What happens if you don't enroll in Medicare Part D in Massachusetts?
While you do not have to sign up for Medicare Part D in Massachusetts, or any other state for that matter, if you delay Part D enrollment and do not have creditable drug coverage elsewhere, you run the risk of lifelong late fees. Creditable drug coverage is coverage considered equal to Medicare in both cost and coverage.
Any time you go longer than 63 days without drug coverage, you begin earning late fees. This fee is paid in addition to your monthly premium the entire time you have Medicare Part D.
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