Prescription drug coverage is not a part of Original Medicare (Parts A and B). Medicare Part D prescription drug coverage became available in 2006, courtesy of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, more commonly known as the Medicare Modernization Act, or MMA. On this page, we describe everything you need to know about Medicare Part D in New Hampshire.
How Does Medicare Part D Work in New Hampshire?
Medicare Part D provides prescription drug coverage in New Hampshire – just as it does across the United States.
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). But for prescription drug coverage, you need Part D. You can get this coverage in one of two ways:
- Sign up for a standalone Medicare Part D prescription drug plan (if you have Original Medicare or a Medicare Advantage [MA] plan that doesn't include drug coverage)
- Join a Medicare Advantage Prescription Drug plan (MA-PD), which gives you the same coverage as Original Medicare and a Part D plan
Please note that you cannot have both an MA-PD and a Part D plan. If you attempt to join a standalone Part D plan after signing up for an MA-PD plan, you will lose your Advantage plan and be placed back in Original Medicare.
Who Qualifies for Medicare Part D in New Hampshire?
If you are enrolled in Medicare Part A and/or Part B, you qualify for Medicare Part D. To buy a specific Medicare plan, you must also live in that plan's service area.
You reach Medicare eligibility at age 65. If you are receiving Social Security benefits at least 4 months before your 65th birthday, Medicare enrollment is automatic. Everyone else has to sign up for Medicare.
If you qualify for Medicare due to a disability, you're automatically enrolled in Parts A and B on your 25th month of receiving Social Security disability benefits.
Nobody is ever automatically enrolled in Medicare Part D. You must always choose to sign up for prescription drug coverage.
Medicare Part D Enrollment Periods in New Hampshire
You can only sign up for Medicare Part D in New Hampshire during specific enrollment periods.
Everyone who is eligible for Medicare gets an Initial Enrollment Period (IEP). It lasts for 7 months, beginning 3 months before the month you become eligible. This is true whether you "age in" to Medicare or qualify due to disability. If your birthday or 25th month of disability benefits occurs in June, then your IEP opens on March 1 and closes on September 30.
If you fail to enroll during your IEP and you don't qualify for a Special Enrollment Period (SEP; see below), you can sign up for Medicare during the General Enrollment Period (January 1 through March 31). After General Enrollment ends, you have from April 1 through June 30 to join a Part D or MA-PD plan.
The Annual Enrollment Period (AEP) is available every year from October 15 through December 7. Current Medicare beneficiaries may sign up for prescription drug coverage at any time during AEP.
If you have an Advantage plan, you may take part in the Medicare Advantage Open Enrollment Period (OEP) that runs from January 1 through March 31. Coverage changes are limited to switching to a new MA plan or returning to Original Medicare. However, you may sign up for Part D during this time if the changes you make result in you losing your prescription drug coverage.
Finally, Special Enrollment Periods let you make coverage changes if you experience certain circumstances, such as moving. Find the full list of special circumstances and SEP guidelines on Medicare.gov.
Comparing Prescription Drug Coverage in New Hampshire
Medicare Part D plans are provided by private insurance companies, which is why coverage and costs vary from plan to plan. Before signing up for one, you need to carefully review your plan options.
Start by making a list of the prescription medications you take and comparing it to the plan's drug formulary. This is the list of medications covered by the plan. If the formulary does not include one or more of your prescriptions, look for a plan that does.
The plan will also place covered medications on drug tiers. Which tier your medication is on indicates how much you'll pay for it, meaning your copays or coinsurance. The lower the tier, the lower your cost.
In addition to copays or coinsurance, your out-of-pocket Part D costs include the yearly deductible and monthly premium. To understand the full cost of the plan, you must look beyond the monthly premium.
You may qualify for Extra Help paying for your prescription drug costs. Eligibility for this Medicare program is based on your income and resource levels. To see whether you qualify for Extra Help in New Hampshire, click here.
Is Prescription Drug Coverage in New Hampshire Mandatory?
Although highly recommended, no part of Medicare is mandatory. However, Medicare encourages timely registration by charging late enrollment fees. Depending on how long you go without creditable drug coverage, these penalties can be significant. You also owe them for the entire time you have Medicare prescription drug coverage.
To be considered creditable, your prescription drug plan must provide similar benefits to what Medicare Part D offers, and for a comparable price. If you have a prescription drug plan that's not through Medicare, your plan provider should notify you whether the coverage is creditable. Keep these notices. They will protect you from paying the late enrollment penalty when you finally do sign up for a Part D plan.
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