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Medicare Part D Coverage in New York

If you receive Medicare coverage in New York, you likely want to know about your prescription drug options. Medicare prescription drug coverage is called Medicare Part D, and you can add it to your Original Medicare (Part A and Part B) coverage or get it with a Medicare Advantage plan with prescription benefits. Learn more about Medicare Part D Coverage in New York so that you can select the appropriate option.

Medicare Part D Coverage Options for Original Medicare

Original Medicare, Part A and Part B, does cover some medications, but it is not a replacement for Medicare Part D. Medicare Part A will cover the medications you receive when you’re at a skilled nursing facility. It also covers medicines administered when you’re admitted to the hospital. Medicare Part B covers medications like vaccines and infusions that you cannot administer on your own.

You will have to pay for all other medications out-of-pocket  unless you enroll in Medicare Part D. Private insurers that are approved by Medicare offer Medicare Part D coverage. If you go this route, your Medicare Prescription Drug Plan will be separate from Medicare Part A and Part B. You will receive healthcare benefits from your Original Medicare plan and prescription drug benefits from your Medicare Part D plan.

Prescription Drug Coverage for Medicare Advantage Plans

If you’re looking for Medicare Part D coverage in New York, you should also consider getting a Medicare Advantage plan that covers prescriptions. These plans combine Medicare Part D coverage and health insurance, so you only have to deal with a single plan. Private insurance companies sell Medicare Advantage (Medicare Part C) plans.

At a minimum, Medicare Part C plans provide the same benefits that are available with Original Medicare. You can also find Medicare Part C plans with other benefits. For instance, you might be able to receive vision, dental, and wellness benefits. Not all Medicare Part C plans have prescription drug coverage, so make sure you choose one that includes this coverage.

How to Enroll in Medicare Part D Coverage in New York

You must have Medicare Part A and/or Part B and live in an eligible service area to get Medicare Part D coverage. In addition, you must enroll during one of the enrollment periods.

You can enroll during the:

  • Initial Enrollment Period (IEP) for Part D
    • For people enrolling when they turn 65, the IEP for Medicare Part D begins three months before their 65th The period ends three months after they turn 65.
    • For people enrolling due to a disability, the IEP begins three months prior to the 25th month of receiving disability benefits and ends three months afterwards.
  • Annual Election Period
    • You can sign up for Medicare Part D or make changes to your plan during the Annual Election Period. The Annual Election Period takes place from Oct. 15 to Dec. 7.
  • Medicare Advantage Disenrollment Period
    • You can change from a Medicare Advantage plan to Original Medicare during this period. The disenrollment period runs from Jan. 1 to Feb. 14. During this time, you also have the option of enrolling in Medicare Part D coverage.
  • Special Election Period
    • If you meet certain criteria, you can change your prescription plan, including adding coverage, during a Special Election Period. Circumstances include moving from the current plan’s service area, losing Medicaid eligibility, moving back to the country after living abroad, and moving to an area with additional Medicare options. These are just a few of the reasons that you might be eligible to enroll in prescription coverage during a Special Election Period.

Enrolling in Medicare Part D

It is critical to enroll in Medicare Part D coverage as soon as you are eligible unless you have creditable prescription coverage. This refers to coverage that is equal to or better than standard Medicare Part D insurance. If you fail to enroll during the Initial Enrollment Period and you don’t have creditable prescription drug coverage for 63 consecutive days, you could be charged a late-enrollment penalty if you decide to add Medicare Part D coverage later on.

The penalty is calculated by multiplying the number of months you went without coverage by 1 percent of the national base beneficiary premium. The national base beneficiary premium is $33.19 in 2019, and it is rounded to the nearest $0.10 for calculation purposes. The penalty is tacked on to your monthly premium for Medicare Part D.

Get Help Selecting Medicare Part D Coverage in New York

Choosing Medicare Part D Coverage in New York can be confusing. Different plans are available in different counties, and each plan has its own set of medications it covers. Take the confusion out of shopping for prescription drug coverage by calling 844-903-4406. You will be connected to a licensed Medicare agent who will help you choose the best prescription drug coverage for your needs.

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