If you are ready to enroll in Medicare, then it is a good idea to learn about Medicare Part D. While Original Medicare (Medicare Part A and Part B) cover hospital and medical insurance, they do not include prescription drug coverage. For that, you need to sign up for a Part D plan.

What is Medicare Part D in Pennsylvania?

Medicare Part D is how Pennsylvanian's get prescription drug coverage. There are two ways to get Part D:

  • Enroll in a standalone Part D plan in addition to Original Medicare or a Medicare Advantage Plan
  • Enroll in a Medicare Advantage Prescription Drug (MA-PD) plan

Though most Medicare Advantage plans include prescription coverage, it is important to make sure it is an MA-PD plan if that is the option you wish to choose. Either way, plans are sold by private insurers contracted with Medicare in Pennsylvania.

Who is eligible for Medicare Part D in Pennsylvania?

Anyone that is eligible for Medicare and enrolled in Medicare Part A and/or Part B can sign up for Medicare Part D. You may also have to meet requirements specific to the plan you want, but usually the only plan-specific requirement is living in its service area.

When can you join a Medicare Part D plan in Pennsylvania?

There are specific times you are able to enroll in Medicare:

  • Initial Enrollment Period (IEP): This is the first time you can sign up for any Medicare products. Your IEP starts three months before the month you turn 65 and lasts for the three months after, for a total of seven months. Once you've signed up for Original Medicare, you can sign up for Part D.
  • General Enrollment Period (GEP): From January 1 through March 31, you can sign up for Original Medicare if you missed your IEP. Immediately after, between April 1 and June 30, you can enroll in a Part D plan.
  • Medicare Annual Enrollment Period (AEP): Every year from October 15 to December 7, current Medicare beneficiaries can make changes to their coverage or sign up for Part D.
  • Medicare Advantage Open Enrollment Period (OEP): If you are enrolled in Medicare Advantage, between January 1 and March 31 you can make changes to your coverage or switch back to Original Medicare. You may only sign up for a Part D plan if any changes you made ends your prescription drug coverage.

Outside of these time periods, you must meet special circumstances (such as moving outside your service area) to qualify for a Special Enrollment Period (SEP).

What to look for in Medicare Part D plans in Pennsylvania

Comparing Medicare Part D plans requires you to thoroughly compare all of your cost and coverage options. Since plans are provided by private insurance companies, your options and the associated costs vary.

The first thing you need to do is check a plan's formulary. This is a tiered list of all the drugs a plan covers, with higher cost medications being in higher tiers. Be sure to check multiple formularies to see where your prescriptions fall. It is also important to consider how your prescription needs may change in the future as you compare options.

Pay attention to the cost of deductibles and monthly premiums as well; your medications costing less doesn't mean much if it is offset by a high monthly payment. If you have limited income or resources, you may qualify for Extra Help, a program that helps to cover prescription drug costs.

Do I need to have Medicare Part D in Pennsylvania?

In a word, no. Just like every other state, Pennsylvania does not require anyone to have Medicare Part D. However, that does not mean you shouldn't sign up as soon as you can. Delaying enrollment in Medicare Part D may cause you to pay lifelong penalties, if you do not have creditable drug coverage elsewhere. Coverage is considered "creditable" if it is equal to Medicare offerings in both cost and coverage.

If you have not signed up for Part D and do not have other coverage, you start earning late fees once you go 63 or more consecutive days with no drug coverage. You pay these fees for as long as you have Medicare Part D.

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