In New Jersey, as in every other state, Original Medicare (Part A and Part B) does not include prescription drug coverage. To get that, you need to sign up for Medicare Part D.
How does Medicare Part D work in New Jersey?
Original Medicare encompasses Part A (hospital insurance) and Part B (medical insurance), neither of which provides prescription medication coverage. For drug coverage, you need either a standalone Medicare Part D plan or a Medicare Advantage Prescription Drug plan (MA-PD).
Medicare Advantage Plans, also known as Medicare Part C, offer the same benefits that Original Medicare does, but typically also offer additional coverage. Common additions include dental care, vision care, and prescription drug coverage. You can add a standalone Part D plan to Original Medicare or a Medicare Advantage plan with no drug coverage. You cannot have a standalone Part D plan and an MA-PD plan.
When can you sign up for Medicare Part D in New Jersey?
Many assume Medicare enrollment is automatic, but this is not the case for everyone. If you began receiving Social Security or Railroad Retirement Board (RRB) benefits four months before you turned 65, then you are automatically signed up. The same is true for those who qualify due to disability and reach their 25th month of collecting benefits. There are a few times in New Jersey you can enroll in Medicare Part D:
- Initial Enrollment Period (IEP): Beginning three months before the month you turn 65 and lasting for the three months after, your IEP in total is a seven month period. This is the first time you can sign up for Original Medicare, Medicare Part C, and Medicare Part D.
- Annual Enrollment Period (AEP): From October 15 through December 7, this is your yearly chance to make coverage changes and sign up for an MA-PD plan or a Part D plan.
- General Enrollment Period (GEP): Though you can sign up for Medicare Part A and Part B during this time (January 1 through March 31), you cannot enroll in a Part D plan. However, from April 1 through June 30, you can join a Part D or MA-PD plan.
- Medicare Advantage Open Enrollment Period (OEP): If you are currently enrolled in Medicare Advantage, from January 1 through March 31, you can switch Advantage plans or go back to Original Medicare. If doing so makes you lose drug coverage, you can also enroll in Part D during this time.
You may also qualify for a Special Enrollment Period (SEP) that allows you to sign up outside of the standard enrollment periods. Special circumstances such as moving outside of your service area or otherwise losing coverage through no fault of your own can qualify you. For a full list of circumstances, check here.
It should be noted that, while there are circumstances that lead to automatic enrollment in Medicare Parts A and B, you are never automatically enrolled in Part D.
Comparing prescription drug plans in New Jersey
Both Part D and MA-PD plans are offered by private insurance companies, so costs vary based on plan and provider. Always be sure to check a plan's drug formulary, which is a tiered list of the medications a plan covers. If the medication you need isn't on it, that plan isn't the right choice for you. You also need to consider out-of-pocket costs, such as:
- Co-pays and co-insurance
- Monthly premium
- Yearly deductible
Copays can be estimated by checking the tier your prescription is on, with lower tiers meaning lower copays. If your resources are limited, you may qualify for Extra Help in New Jersey; the program helps pay out-of-pocket prescription drug costs.
Is prescription drug coverage in New Jersey mandatory?
The short answer is no, you cannot be forced to buy a Medicare Part D or MA-PD plan, or any other part of Medicare for that matter. However, if you do not have creditable drug coverage elsewhere (coverage as good as Medicare in terms of both cost and benefits), you risk late penalties for delaying enrollment.
This penalty hits any time you go 63 days or more without any creditable prescription drug coverage, and you pay the penalty for the entire the time you have a Part D plan.
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