Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. It does not cover prescription medications. For that, you need Part D. This page explains everything you need to know about Medicare Part D in Ohio.
What are your Medicare Part D options in Ohio?
As in the rest of the country, you have two Medicare Part D options in Ohio:
- A standalone Medicare Part D plan
- A Medicare Advantage Prescription Drug plan (MA-PD)
You may pair a standalone Part D prescription drug plan with either Original Medicare or a Medicare Advantage (MA) plan that does not include drug coverage. Although all Advantage plans must offer the same benefits as you'd get with Original Medicare, additional coverage options vary.
If you want an Advantage plan that includes prescription drug coverage, look for the MA-PD designation when comparing your Ohio Part D options.
How do you qualify for Medicare Part D in Ohio?
If you have Medicare Part A and/or Part B, you qualify for Medicare prescription drug coverage in Ohio.
Most people qualify for Medicare when they turn 65. If you were already receiving Social Security benefits at least 4 months before turning 65, you will be automatically enrolled in Medicare Parts A and B. Everyone else has to apply for benefits.
If you became eligible for Medicare due to a disability, you will be automatically enrolled in Parts A and B in your 25th month of collecting Social Security disability benefits.
When it comes to Medicare Part D, however, you must always choose to sign up – even if you were automatically enrolled in Parts A and B.
When can you enroll in Medicare Part D in Ohio?
Medicare restricts Part D enrollment to certain times. The first is your Initial Enrollment Period (IEP).
Your Initial Enrollment Period lasts a full 7 months, beginning 3 months before you first become eligible for Medicare. This means the month you turn 65 OR your 25th month of collecting Social Security disability benefits. So, if you become eligible for Medicare in July, your IEP begins on April 1 and ends on October 31. Once you register for Part A and/or Part B, you may then join an Ohio prescription drug plan.
People who fail to sign up during their IEP and don't qualify for a Special Enrollment Period (SEP) must wait to sign up for Part A and/or B during General Enrollment, which runs from January 1 through March 31. Once General Enrollment ends, you have from April 1 through June 30 choose a prescription drug plan.
Once you're enrolled in Medicare, you can make Part D changes during the Annual Enrollment Period (AEP), which runs from October 15 through December 7.
The Medicare Advantage Open Enrollment Period is reserved for those covered by an MA plan. Changes are limited to switching to a new Advantage plan or returning to Original Medicare. However, if making that change results in you losing your prescription drug coverage, you may also join a standalone Part D plan.
Finally, if you experience certain circumstances, such as losing your current coverage, you may qualify for a Special Enrollment Period. There are many ways to qualify for an SEP. Medicare.gov has the full list.
Comparing Medicare prescription drug plans in Ohio
When comparing your Part D plan options in Ohio, you need to look at two things: Coverage and costs.
The first thing to check is the plan's drug formulary, which is the list of covered prescription medications. All Part D and MA-PD plans have a formulary. If it doesn't include one or more of your prescriptions, keep looking until you find a plan that does.
Your out-of-pocket costs under Medicare Part D include the annual deductible, monthly premium, and copays or coinsurance. You can estimate your copayment amount by seeing which drug tier your medications are on when you review the formulary. Drugs on the lower tiers cost less than those on the higher tiers.
Extra Help paying your prescription drug costs is available to Medicare beneficiaries who have limited income and resources. If Medicare or Social Security did not notify you that you qualify for Extra Help in Ohio and you think you should, call your plan.
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