Original Medicare, signed into law by President Johnson in 1965, helps seniors pay their healthcare costs after they retire. But Medicare didn't cover prescription medications until Congress passed the Medicare Modernization Act (MMA) in 2003. This legislation increased beneficiaries' Medicare plan options by introducing Part C (Medicare Advantage) and Part D (prescription drug coverage). On this page, we explain Medicare Part D in South Carolina.
How Can You Get Medicare Part D in South Dakota?
You have two options to get Medicare prescription drug coverage in South Carolina:
- A standalone Medicare Part D prescription drug plan (PDP)
- A Medicare Advantage Prescription Drug plan (MA-PD)
Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Medicare Advantage plans provide the same benefits as Original Medicare does but most also offer additional coverage. The most common add-ons are prescription drug coverage, routine vision and dental care, and fitness programs.
You can add a standalone Part D plan to either Original Medicare or an MA plan that doesn't cover prescription medications. (This includes around 10 percent of MA plans.)
If you're looking for an all-in-one plan, a Medicare Advantage Prescription Drug plan is your best bet. MA-PD plans combine Original Medicare and Part D benefits in a single policy.
Please note that you cannot have both an MA-PD plan and a standalone Part D plan.
Who Is Eligible for Medicare Part D in South Dakota?
If you have Medicare Part A and/or Part B, you also qualify for Part D in South Carolina. In addition, you must also live in the prescripotion drug plan's service area.
U.S. citizens and permanent legal residents are eligible for Medicare when they turn 65. Enrollment is only automatic if you began receiving Social Security benefits at least 4 months before your 65th birthday. Everyone else has to apply for Medicare through Social Security.
You can qualify for Medicare before turning 65 if you collect Social Security disability benefits for 24 months. In this case, you will be automatically enrolled in Medicare Parts A and B in your 25th month.
You will never be automatically enrolled in Medicare Part D. Even you already collect Social Security, you must opt in to a prescription drug plan.
When Can You Enroll in a Prescription Drug Plan in South Dakota?
Medicare Part D enrollment in South Carolina in limited to specific times.
- Initial Enrollment Period: Your IEP begins 3 months before the month you become eligible for Medicare and lasts for a full 7 months. So, if your 65th birthday or 25th month of collecting disability benefits occurs in August, your IEP begins on May 1 and ends on November 30. Once you sign up for Part A and/or Part B, you may then join a Part D prescription drug plan.
- General Enrollment Period: Between January 1 and March 31, anyone who missed their IEP and also doesn't qualify for a Special Enrollment Period (SEP) may sign up for Medicare Part A and/or Part B. You may then join a prescription drug plan from April 1 through June 30.
- Medicare Annual Enrollment Period: AEP runs from October 15 through December 7 and is available to current Medicare beneficiaries. During this time, you can change anything you need to regarding your Medicare coverage, including joining an MA-PD or Part D plan.
- Medicare Advantage Open Enrollment Period: Between January 1 and March 31, if you're enrolled in a Medicare Advantage plan, you may either switch to a new MA plan or return to Original Medicare. If you lose your prescription drug coverage after making that change, you may also sign up for a standalone Part D plan.
- Special Enrollment Periods: Certain life changes, such as moving to a new address or losing your current coverage, may qualify you for a Special Enrollment Period. Medicare.gov provides the full list of qualifying special circumstances here.
Comparing Medicare Part D Plans in South Dakota
Private insurance companies provide Medicare prescription drug plans in South Carolina, so coverage and costs may vary widely. To get the best plan for your unique needs and budget, you should compare your Medicare Part D options carefully.
Start by creating a list of your prescriptions and then comparing it to the plan's drug formulary, which is simply a list of medications covered by the plan. If the formulary doesn't include one or more of your prescriptions, keep looking until you find a plan that does.
Review the drug tiers next. This tells you what your approximate copayment or coinsurance will be for a particular medication. Drugs on a lower tier cost less, with copays increasing on the upper tiers.
In addition to copays or coinsurance, your out-of-pocket costs for Medicare Part D may include an annual deductible and monthly premium. You need to look at all three metrics to understand the full cost of a plan.
Extra Help is available to Medicare beneficiaries who have limited income and resources. Medicare or Social Security should notify you via mail if you qualify for Extra Help in South Carolina. If you weren't notified but think you meet the requirements, contact your plan provider.
Please note that all communications from both Medicare and Social Security are via U.S. mail. Unless you specifically request it, nobody from either program will ever call you. If someone calls claiming to be from Medicare or Social Security, hang up the phone. Then, call the appropriate program (1-800-MEDICARE or 1-800-772-1213) and follow their instructions.
Do You Have to Have Medicare Part D in South Dakota?
No, there is no law that requires you to have Medicare Part D in South Carolina. However, the Medicare program encourages timely enrollment by penalizing people who qualify for Part D but delay signing up AND do not have creditable coverage elsewhere. To be considered creditable, your prescription drug plan must offer comparable benefits to what you'd get with Medicare Part D and at a similar price. If you go 63 days or more without creditable coverage, you face lifelong late penalties when you do finally join a Part D plan.
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