If you are enrolling in Original Medicare (Medicare Parts A and B), it is important to understand that prescription drug coverage is not included. For that, you would need to sign up for Medicare Part D.
How does Medicare Part D work in Montana?
In Montana, as in every other state, Medicare Part D is Medicare's prescription drug coverage. Original Medicare only provides hospital insurance (Part A) and medical insurance (Part B), so if you do not already have creditable drug coverage elsewhere (coverage equal to Medicare in both cost and coverage) you need to sign up for a drug plan.
To get prescription drug coverage, you can either sign up for a standalone Part D plan, or a Medicare Advantage Prescription Drug (MA-PD) plan. For either option, plans are offered by private insurance companies contracted with Medicare. You can have a standalone Part D plan in combination with Original Medicare or a Medicare Advantage plan that does not include drug coverage. You cannot, however, have both a Medicare Part D plan and an MA-PD plan.
Who is eligible for Medicare Part D in Montana?
As long as you are enrolled in Original Medicare, you are eligible for Medicare Part D in Montana. You must sign yourself up for Medicare Parts A and B unless you started receiving Social Security benefits at least four months before turning 65. In this case, you would be automatically enrolled.
When can you enroll in Medicare Part D in Montana?
Medicare enrollment is limited to specific time periods:
- Initial Enrollment Period (IEP): This seven-month period starts three months before the month you turn 65 and lasts for the following three months. This is the first time you are able to sign up for any Medicare coverage.
- General Enrollment Period (GEP): From January 1 through March 31, you can sign up for Original Medicare if you missed your IEP. Though you cannot enroll in an MA-PD or Medicare Part D plan during this period, you can from April 1 through June 30.
- Medicare Annual Enrollment Period (AEP): Between October 15 and December 7 you can make several changes to your Medicare enrollment, so long as you are a current Medicare beneficiary.
- Medicare Advantage Open Enrollment Period (OEP): If you have a Medicare Advantage plan, from January 1 through March 31, you can switch Medicare Advantage plans or return to Original Medicare. If these changes cause you to lose drug coverage, you may also enroll in a standalone Part D plan.
To enroll in Medicare Part D outside of these periods, you must qualify for a Special Enrollment Period (SEP). For a list of qualifying circumstances, check here.
How to compare Medicare Part D plans in Montana
As stated above, Medicare Part D plans are offered by private insurance companies, so costs and coverage options vary based on the provider and plan you choose. It is important to thoroughly compare plans before making your decision to ensure you have the best plan for your budget and prescription needs.
Be sure to review any prospective plan's formulary, the tiered list of prescription medications covered by the plan. Remember that drugs in higher tiers cost more than those in lower tiers. If you cannot find the medication you need, move on to the next plan. Out-of-pocket costs, such as copays, deductibles, and monthly premiums, are also important factors to consider. You don't want to pick a plan with a low deductible, only to have it negated by other costs.
If you find yourself with limited resources, you may qualify for Extra Help, a Medicare program that helps to pay prescription drug costs.
Do you have to sign up for Medicare Part D in Montana?
Like all the other parts of Medicare, Part D is not mandatory in Montana or any other state. However, if you delay coverage, you risk lifelong late fees if you do not already have creditable coverage.
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