Orignal Medicare (Parts A and B) never included prescription drug coverage. In an attempt to help seniors cover their rising drug costs, Congress passed the Medicare Mondernization Act in 2003. This legislation expanded choice and coverage to tens of millions of Americans and in 2006, Medicare Part D in Oklahoma became a reality.
How Does Medicare Part D Work in Oklahoma?
Original Medicare includes two parts:
- Part A covers inpatient services received in a hospital or skilled nursing facility (NSF)
- Part B covers outpatient services, such as doctor visits, lab work, and durable medical equipment (DME)
Medicare Part C is more commonly known as Medicare Advantage (MA). Like Part D, we have the MMA to thank for Medicare Advantage plans, which must offer the same benefits as Original Medicare does.
Your Medicare prescription drug plan options in Oklahoma are either a standalone Part D plan or a Medicare Advantage Prescription Drug plan (MA-PD). You may pair a standalone Part D plan with either Original Medicare or an MA plan that does not cover prescriptions. But you cannot have both an MA-PD and a standalone Part D plan.
Who Is Eligible for Medicare Part D in Oklahoma?
If you have Medicare Part A and/or Part B, you are eligible for Medicare Part D in Oklahoma. In addition, you must also live in the prescription drug plan's service area.
If you are a U.S. citizen or permanent legal resident, you become eligible for Medicare when you turn 65. Enrollment in Parts A and B is only automatic if you began collecting Social Security benefits at least 4 months before your 65th birthday. Otherwise, you need to apply for Medicare through Social Security.
You may also qualify for Medicare if you collect Social Security benefits for 24 months. In that case, you are automatically enrolled in both Part A and Part B during your 25th month.
No matter how you qualify for Medicare, you will never be automatically enrolled in Part D. You must always choose to sign up for a prescription drug plan.
When Can You Enroll in Medicare Part D in Oklahoma?
You have to wait for certain enrollment periods before you can sign up for a prescription drug plan in Oklahoma.
Your Initial Enrollment Period (IEP) begins 3 months before the month you become eligible for Medicare and lasts for a full 7 months. For example, if your 65th birthday or 25th month collecting Social Security disability benefits is in April, your IEP begins on January 1 and ends on July 31. Assuming you sign up for Part A and/or Part B during your IEP, you may then join a prescription drug plan.
Those who miss their Initial Enrollment Period and do not qualify for a Special Enrollment Period (SEP) have to wait until General Enrollment, which runs from January 1 through March 31. During General Enrollment, you may sign up for Part A and/or B. However, you have to wait until April 1 to join a Part D plan. That window closes on June 30.
Current Medicare beneficiaries may make a variety of changes to their coverage during the Annual Enrollment Period (AEP). You have from October 15 until December 7 to sign up for a new prescription drug plan during AEP.
The Medicare Advantage Open Enrollment Period is restricted to beneficiaries who are currently enrolled in an Advantage plan. It lasts from January 1 until March 31. During this time, you may either change to a new MA plan or switch back to Original Medicare. If you lose your prescription drug coverage as a result of that change, though, you may also enroll in a standalone Part D plan.
Medicare provides Special Enrollment Periods to beneficiaries who experience certain life changes, such as moving to a new address or losing their current coverage through no fault of their own. Find the full list of special circumstances on Medicare.gov.
How to Compare Prescription Drug Plans in Oklahoma
Private insurance companies provide both standalone Part D and MA-PD plans in Oklahoma, which means coverage and costs may vary considerably from plan to plan. You need to compare your options carefully to be sure you're getting the best plan for your unique needs and budget.
Start by looking at the plan's drug formulary. This is the list of medications the plan covers, and it's probably the most important metric when comparing your options. After all, what's the point of joining a prescription drug plan that doesn't cover your prescriptions?
While reviewing the formulary, take a look at the drug tiers as well. All Part D plans use tiered pricing, with medications on the lower tiers costing less than those at the top. If you know which tier your medications are on, you can estimate what your copays will be.
That brings us to costs. Your out-of-pocket costs for Medicare Part D may include the annual deductible, monthly premiums, and copays or coinsurance. Review these carefully, since low premiums often hide higher costs elsewhere.
Medicare beneficiaries who have limited income and resources may qualify for Extra Help, a program that helps cover prescription drug costs. You should receive notification from either Medicare or Social Security if you qualify. However, if you did not and you think you meet the requirements for Extra Help in Oklahoma, you should call your plan.
Please note that all communication from Medicare and Social Security is via U.S. mail. If anyone calls you claiming to be from Medicare or Social Security AND you did not specifically request a call, hang up. Then call the appropriate entity and follow their instructions (1-800-MEDICARE or 1-800-772-1213).
Do You Have to Have Medicare Part D in Oklahoma?
No part of Medicare is mandatory in Oklahoma, including Parts A, B, and D. However, you do risk lifelong late fees if you fail to sign up for Part D and do not have creditable coverage elsewhere (i.e. a plan that is comparable to Medicare in terms of price and benefits).
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