Once you are ready to enroll in Medicare, it is time to learn about Medicare Part D. While most people think of Medicare Parts A and B (Original Medicare) or Medicare Advantage, it is important to understand Medicare's prescription drug coverage: Medicare Part D.
What is Medicare Part D in Washington?
To put it simply, Medicare Part D is how Washington residents get prescription drug coverage from Medicare. Your options are enrolling in a standalone Part D plan or a Medicare Advantage Prescription Drug (MA-PD) plan. Be sure the Medicare Advantage plan is designated as an MA-PD if that is the option you prefer.
Whether you choose a standalone plan or an MA-PD plan, coverage is offered by private insurers contracted with Medicare.
Medicare Part D requirements in Washington
As soon as you have signed up for Medicare Parts A and/or B, you are eligible for Medicare Part D in Washington.
When can you sign up for Medicare Part D in Washington?
You can only enroll in Medicare during specific time frames:
- Initial Enrollment Period (IEP): Your IEP is unique to you, and starts three months before you turn 65 and lasts for the following three months, giving you a total of seven months to enroll.
- General Enrollment Period (GEP): While you cannot sign up for Medicare Part D during the GEP (January 1 to March 31), you can enroll from April 1 through June 30.
- Annual Enrollment Period (AEP): Every year between October 15 and December 7, current Medicare enrollees are able to sign up for Medicare Part D plans.
- Medicare Advantage Open Enrollment Period (OEP): If you are a Medicare Advantage beneficiary, between January 1 and March 31, you can make changes to your MA coverage or go back to Original Medicare. If these changes cause you to lose prescription drug coverage, then you can sign up for Part D.
If you miss these periods, you would have to qualify for a Special Enrollment Period (SEP) to enroll. For a list of qualifying circumstances, such as moving outside of your coverage area or any other no-fault coverage loss, check here.
What to look for in a Medicare Part D plan in Washington
The very first thing you should look at in a plan is its formulary, the tiered list of covered drugs. Medications in higher tiers cost more, so you want to ensure both that your medications are covered and that they are in an affordable tier.
Also be sure to weigh the cost of copays against deductibles and premiums. You don't want affordable prescriptions offset by a high monthly premium, or vice versa. Should you feel income or resources are limited, you may qualify for Extra Help. This program is designed to help cover the costs that come with a Part D plan.
What happens if you don't sign up for Medicare Part D in Washington?
Medicare Part D (or any other aspect of Medicare) is not mandatory in Washington or any state. However, the longer you delay sign up, the higher the chance of accruing late penalties. For every 63 days you go without creditable drug coverage, you begin building fees that must be paid for as long as you have Medicare Part D. Coverage is considered "creditable" so long as it is comparable to Medicare in terms of cost and level of coverage.
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