When it comes time to enroll in Medicare, most people think about Original Medicare (Medicare Part A and Part B) or Medicare Advantage (Medicare Part C). But if you are ready to sign up, it is important to learn about Medicare Part D.
What is Medicare Part D in Texas?
Medicare Part D is how Texans get prescription drug coverage through Medicare. You can sign up for a standalone Part D plan or for a Medicare Advantage Prescription Drug (MA-PD) plan. Both options are provided by private insurers that contract with Medicare in Texas.
Although the majority of Medicare Advantage plans include drug coverage, if that is what you want, you need to make sure the plan is designated as an MA-PD.
Who is eligible for Medicare Part D in Texas?
If you are signed up for Medicare Part A, Part B, or both, you can enroll in Medicare Part D in Texas. The plan you choose may have its own requirements, but there is not typically much required beyond living in the plan's service area.
When can you sign up for Medicare Part D in Texas?
Enrollment in Medicare Part D is limited to specific time periods.
- Initial Enrollment Period (IEP): Starting three months before the month of your 65th birthday and lasting for the three months following, your IEP is the first time you can enroll in Medicare.
- After the General Enrollment Period (GEP): Though you cannot sign up for Part D during the GEP (January 1 to March 31), you can enroll in a Part D plan between April 1 and June 30.
- Annual Enrollment Period (AEP): From October 15 through December 7, current Medicare beneficiaries can enroll in Part D.
- Medicare Advantage Open Enrollment Period (OEP): Also between January 1 and March 31, the OEP allows Medicare Advantage beneficiaries to make plan changes, switch back to Original Medicare, and sign up for Part D if any changes cause you to lose drug coverage.
If you are unable to enroll during any of these periods, you would have to wait until it comes back around, unless you qualify for a Special Enrollment Period (SEP). Moving outside your plan's service area is an example of a qualifying circumstance. For a full list, check here.
What to look for in Medicare Part D plans in Texas
Finding a Medicare Part D plan in Texas is all about making sure your prescription needs are met within your budget.
The first thing to look at is a plan's formulary. This is a tiered list of all the drugs a plan covers, with drugs in higher tiers having a higher copay. You want to verify both that a plan covers your medication and that it is affordable. But don't choose a plan solely on the cost of your medications, be sure to weigh that against the deductible and monthly premium amounts.
If your income or resources are limited, you might qualify for Extra Help, a program designed to help cover the costs of Medicare Part D.
Do you have to sign up for Medicare Part D in Texas?
While you do not have to sign up for Medicare Part D in Texas, it is highly recommended that you do. The longer you wait to sign up, the higher the chance of accruing lifelong late fees. You can avoid these fees if you don't have Part D so long as you do have creditable drug coverage elsewhere. This would be coverage considered equal or comparable to Medicare in terms of cost and scope.
Any time you go 63 days without drug coverage, you start building up late penalties. These fees are added to your monthly premium and must be paid for as long as you have Medicare Part D.
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