According to the Centers for Medicare and Medicaid Services, nearly a half-million people living in Nevada are Medicare beneficiaries. Around 70 percent of those people are enrolled in a Medicare Part D plan to help cover the costs of prescription medication.
Understanding Medicare Part D in Nevada
As it does across the country, Medicare Part D provides prescription drug coverage in Nevada. It was introduced in 2006 and is not part of Original Medicare, which consists of hospital insurance (Part A) and medical insurance (Part B). There is also Medicare Part C, which is more commonly known as Medicare Advantage (MA).
You have two options to get Part D prescription drug coverage in Nevada:
- A standalone Medicare Part D plan
- A Medicare Advantage Prescription Drug plan (MA-PD)
Medicare Advantage plans offer the same coverage you get with Original Medicare, although most provide additional benefits. Prescription drug coverage, routine dental and vision care, and fitness programs are the most common add-ons.
Around 10 percent of Advantage plans do not include prescription drug coverage. If you want an all-in-one plan, look for the MA-PD designation. At a minimum, you know this plan will provide everything you have with Original Medicare plus a Part D plan.
You can add a standalone Part D plan to an MA plan but not to an MA-PD plan. If you're enrolled in a Medicare Advantage Prescription Drug plan and then sign up for a standalone Part D plan, you will lose your Advantage plan and be placed back in Original Medicare.
When Do You Qualify for Medicare Part D in Nevada?
Once you're enrolled in Medicare Part A and/or Part B, you qualify for Medicare Part D.
Most people become eligible for Medicare when they turn 65. However, they are only automatically enrolled in Medicare if they began receiving Social Security benefits at least 4 months before their 65th birthday. Everyone else must choose to sign up for Medicare.
Around 15 percent of Medicare beneficiaries qualify due to a disability. In this case, you are automatically enrolled in both Parts A and B on your 25th month of collecting Social Security disability benefits.
Please note that, no matter what your Social Security status is, you will never be automatically enrolled in Medicare Part D.
When Can You Sign Up for Medicare Part D in Nevada?
As in the rest of the country, Medicare Part D enrollment in Nevada is restricted to certain times.
- Your Initial Enrollment Period (IEP) lasts for 7 months and begins 3 months before the month you become eligible for Medicare. This is true whether you qualify based on age or disability. So, if you become eligible for Medicare in May, your IEP begins on February 1 and ends on August 31. Once you have Part A and/or Part B, you may enroll in a Part D at any time during your IEP.
- The General Enrollment Period lasts from January 1 through March 31. It is available to anyone who is eligible for but not currently enrolled in Part A and/or Part B. Please note that you may only enroll in Parts A and B during General Enrollment. If you do that, the window to sign up for prescription drug coverage opens on April 1 and closes on June 30.
- Medicare's Annual Enrollment Period (AEP) lasts from October 15 through December 7. If you are currently enrolled in Medicare, you can use AEP to enroll in a Part D or MA-PD plan.
- The Medicare Advantage Open Enrollment Period (OEP) runs from January 1 through March 31. Current Medicare Advantage beneficiaries may either sign up for a new MA plan or return to Original Medicare. If the changes you make lead to you losing prescription drug coverage, you may also sign up for a Part D plan.
- Special Enrollment Periods (SEPs) are available to any Medicare beneficiary experiencing a specific change, such as moving or losing coverage. Click here to see if you qualify for an SEP that would let you change your prescription drug coverage.
How to Compare Medicare Part D Plans in Nevada
To find the right plan for you, you need to review the plan's drug formulary as well as how much it costs.
A drug formulary is simply the list of prescription medications covered by the plan. And if it doesn't include your medications, look for another plan.
You should also see which tier the plan places your prescriptions on. Part D plans place covered medications on tiers, which indicate how expensive the drug is. The higher the tier, the higher your copay or coinsurance will be.
Your out-of-pocket costs under Medicare Part D include the monthly premium, annual deductible, and copays or coinsurance. Look at all three costs to understand your true out-of-pocket.
Many Medicare beneficiaries qualify for Extra Help paying the costs of their prescription medications. To see whether you qualify, click here.
Do You Have to Have Prescription Drug Coverage in Nevada?
No, nobody can force you to sign up for Medicare Part D (or Parts A, B, or C). But, if you don't have creditable prescription drug coverage someplace else, you face lifelong late fees when you do finally sign up for Part D.
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