If you are eligible for Medicare Part A and Part B, also known as Original Medicare, it is important to understand that neither "part" of Original Medicare covers prescription drugs. Medicare's prescription drug coverage comes through Medicare Part D.
How do you get Medicare Part D in Utah?
To get Medicare Part D in Utah, you can either sign up for a standalone Part D plan or a Medicare Advantage Prescription Drug (MA-PD) plan. Regardless of which option you choose, plans are offered through private insurance companies, so costs and coverage varies.
You can attach a standalone Part D plan Original Medicare or to a Medicare Advantage plan that does not have prescription drug coverage. If you choose to go with an MA-PD plan, all of your Original Medicare benefits and your medication coverage will be through a single policy.
It is important to note that you cannot have an MA-PD plan and a standalone Part D plan.
Who is eligible for Medicare Part D in Utah?
If you are enrolled in Medicare Parts A and/or B, then you are eligible for Medicare Part D. Though you become eligible for Medicare when you turn 65, enrollment is only automatic if you began receiving Social Security or Railroad Retirement Board benefits at least four months before your 65th birthday. However, regardless of circumstances, you will never be automatically enrolled in Medicare Part D.
When can you join a prescription drug plan in Utah?
There are set times you can sign up for a Medicare Part D plan in Utah:
- Initial Enrollment Period (IEP): This seven-month period starts three months before the month you turn 65 and lasts through the three following months. This is the first time you can sign up for Medicare and, once you've enrolled in Parts A and/or B, you may sign up for Part D.
- General Enrollment Period (GEP): Though you can only sign up for Medicare Parts A and B during this time (January 1 through March 31), you can enroll in Part D immediately after from April 1 through June 30.
- Medicare Annual Enrollment Period (AEP): Current Medicare beneficiaries can make changes to existing coverage, including prescription drug coverage, from October 15 through December 7 every year.
- Medicare Advantage Open Enrollment Period (OEP): From January 1 to March 31, Medicare Advantage beneficiaries can return to Original Medicare or switch to a different MA plan. You may also sign up for a standalone Part D plan if any changes you make cause you to lose drug coverage.
If you miss these set periods, you must qualify for a Special Enrollment Period (SEP) to enroll. A full list of special circumstances, such as no-fault coverage loss, can be found here.
How to compare Medicare Part D plans in Utah
Because Medicare Part D plans are offered by private insurance companies contracted with Medicare in Utah, any costs and coverage options vary based on the provider. It is important to carefully compare plans to make sure you have the best choice for your budget.
First, you need to check a plan's formulary, the list of medications a plan covers. Formularies are tiered, with drugs in higher tiers coming at a higher cost, so be sure to check multiple plans to get the best deal.
You also need to consider the cost of a deductible or any monthly premiums the plan may include, as that can offset low medication costs. Should you find yourself with limited income or resources, you might qualify for Extra Help. This Medicare program helps you cover a variety of Part D costs.
Do you have to have Medicare Part D in Utah?
Medicare Part D is not mandatory in Utah or any other state. But you do run the risk of lifelong late penalties if you delay enrollment without also having creditable drug coverage from somewhere else. Coverage is considered "creditable" so long as the cost and coverage of your plan is comparable to Medicare Part D. Once you go 63 days or longer without creditable drug coverage, you begin accruing late fees.
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