Medicare Part D Plans in Montana
If you qualify for Medicare and are looking for prescription drug coverage in Montana, you can get it with a Medicare Part D plan. Since Original Medicare (Parts A and B) does not include coverage for prescription medications, Congress passed the Medicare Modernization Act (MMA) in 2003. This legislation led to the introduction of Medicare Part D in 2006.
How Does Medicare Part D Work in Montana?
Medicare Part D provides prescription drug coverage in Montana, just as it does across the United States. Although Original Medicare provides hospital insurance through Part A and medical insurance through Part B, it has no provisions for prescription drug coverage. Once Congress passed MMA, private insurance companies were able to sell Medicare plans, including Part D prescription drug plans (PDPs) and Medicare Advantage (MA) plans.
Medicare Advantage plans must provide the same benefits you'd get with Original Medicare. However, most of them (over 90 percent) also offer additional benefits. The most common extras are prescription drug coverage, fitness programs, and routine vision and dental care.
You can get prescription drug coverage in Montana by signing up for a standalone Medicare Part D plan or a Medicare Advantage Prescription Drug plan (MA-PD). You can add a Part D plan to either Original Medicare or an MA plan. However, you cannot have both an MA-PD plan AND a standalone Part D plan. If you attempt to enroll in a standalone plan after signing up for Medicare Advantage Prescription Drug plan, you will be disenrolled from the MA-PD plan and placed back in Original Medicare.
Who Is Eligible for Medicare Part D in Montana?
If you're enrolled in Medicare Part A and/or Medicare Part B, you're eligible for Medicare Part D in Montana. In addition, you must meet the Part D plan's eligibility requirements. Typically, the only requirement is living in the plan's service area.
When Can You Enroll in Medicare Part D in Montana?
Signing up for a Medicare plan is limited to specific enrollment periods.
If you age-in to Medicare, your Initial Enrollment Period (IEP) begins 3 months before your 65th birthday. It lasts for a full 7 months, ending 3 months after your birth month. You will be automatically enrolled in Medicare Parts A and B if you begin receiving Social Security benefits at least 4 months before your birthday. Otherwise, you need to sign up for Medicare.
Please note that you will never be automatically enrolled in Medicare Part D, even if you retired before turning 65.
People who qualify for Medicare due to a disability also get a 7-month Initial Enrollment Period. You will be automatically enrolled in Parts A and B in your 25th month of receiving Social Security disability benefits. Your IEP starts 3 months before that and ends 3 months later (months 22 and 28 respecively). Again, you will not be automatically enrolled in Part D. You must choose a prescription drug plan and sign up through the private insurance company that offers the plan.
Additional Medicare Part D enrollment periods include:
- General Enrollment Period (GEP): If you don't sign up for Medicare during your IEP, the General Enrollment Period is available from January 1 through March 31. Although you cannot sign up for a Part D or MA-PD plan during GEP, you can enroll in one anytime between April 1 and June 30.
- Medicare Annual Enrollment Period (AEP): You can make a variety of Medicare changes every year from October 15 through December 7. AEP is only available to current Medicare beneficiaries. Everyone else has to wait until General Enrollment.
- Medicare Advantage Open Enrollment Period (OEP): If you're enrolled in an Advantage plan, your have two options during OEP: Choose a new MA plan or return to Original Medicare. However, if making that change means you lose your prescription drug coverage, you may also buy a Part D plan.
- Special Enrollment Period (SEP): If you meet one of Medicare's special circumstances (find the full list here), you may be able to sign up for a Part D plan during a Special Enrollment Period.
How to Compare Medicare Part D Plans in Montana
Since Part D plans are sold by private insurance companies, costs and coverage vary according to the plan you choose. That's why we recommend comparing your options carefully to find the best Part D coverage for your unique needs and budget.
Your first step should be comparing a list of prescription medications you take with the plan's drug formulary. This is the list of prescription medications covered by the Part D plan.
Reviewing your out-of-pocket costs under the plan comes next. These include the annual deductible, monthly premium, and copays or coinsurance. It's important to remember that a rock-bottom premium may be hiding higher out-of-pocket costs.
To estimate your copays, see where your medications fall on the plan's drug tiers. Lower tiers are where you find the least expensive medications, typically generic drugs. The higher tiers are where you find brand name and specialty drugs. It's also where you find higher prices. The more tiers there are, the lower your cost will be for tiers 1 and 2.
You may qualify for Extra Help if you have limited income and/or resources. This Medicare program helps beneficiaries pay a variety of their prescription drug costs. To see if you qualify for Extra Help, visit Medicare.gov here.
Do You Have to Sign Up for Medicare Part D in Montana?
Technically, you never have to sign up for any part of Medicare. However, if you delay Medicare enrollment and you don't have creditable coverage through another insurance provider, you face significant and lifelong late penalties when you do finally sign up for Medicare.
Medicare defines creditable coverage as a plan that offers comparable benefits for around the same price you'd pay for Medicare Part D.