If you have Original Medicare (Part A and Part B), you may think you have all the coverage you need, but that isn’t necessarily the case. Original Medicare does not cover prescription medications, with a few exceptions, such as IV infusions and vaccinations. Fortunately, you can get coverage by adding Medicare Part D coverage in Pennsylvania. Unlike Medicare, Medicare Part D is issued by private insurance companies. To offer a Medicare Part D policy, the company must be approved by Medicare.
You have two different options for getting prescription drug coverage with Medicare. If you want to stick with Original Medicare, you will need to get Medicare Part D. Medicare Part D is a standalone policy, meaning it works alongside Original Medicare.
Medicare Part D can also be added to some Medicare Medical Savings Account Plans, Medicare Private Fee-for-Service Plans, and Medicare Cost Plans. If you are unsure if your plan is eligible for Medicare Part D coverage in Pennsylvania, speak to an insurance agent.
You also have the option of getting prescription drug coverage through a Medicare Advantage Prescription Drug plan. If you go this route, your Medicare benefits will not come through the government. Instead, you will purchase a policy from a private insurance company that is approved by Medicare.
Medicare Advantage (Part C) plans are required to at least provide the same benefits available with Original Medicare (Part A and Part B). Often, the plans include additional benefits, such as fitness programs, vision care, and dental services. Not all Medicare Advantage plans include prescription coverage. You need to get a Medicare Advantage Prescription Drug plan to get prescription coverage.
Unlike Medicare Part D, a Medicare Advantage Prescription Drug plan is a single policy. Your healthcare services and prescription drugs are covered in a single plan.
Medicare Part D coverage is available if you have Medicare Part A and/or Medicare Part B, live in an area where the plan is offered, and enroll during a specific period. There are four enrollment periods available.
The Initial Enrollment Period is when most people sign up for Medicare Part D. This period begins three months before you turn 65 and ends three months after your birthday month.
You can enroll during the IEP if you receive Medicare benefits due to a disability. In this case, the IEP begins three months before the 25th month of receiving Railroad Retirement Board or social security benefits. It ends three months after the 25th month of receiving benefits.
You can also add Medicare Part D coverage during the Annual Election Period from Oct. 15 to Dec. 7. Along with adding Medicare Part D, you have the option to make additional changes to your plan.
What if you have a Medicare Advantage plan and prefer Original Medicare with Medicare Part D coverage? You can make that change during the disenrollment period. This period starts on Jan. 1 and ends on Feb. 14.
Special Election Periods can take place during any time of the year. You can purchase a Medicare Part D plan during a Special Election Period if you have lost coverage due to a matter outside of your control or if you have moved back to the country after living abroad. If you are unsure if you qualify for a special election period, a licensed insurance agent can help.
Waiting too long after the IEP to buy Medicare Part D can lead to an expensive penalty that will be added to your monthly premium. If you don’t have Medicare Part D or creditable prescription coverage for at least 63 days after the IEP, the government will assess you a penalty when you add the coverage later. The longer you go without coverage, the more expensive your penalty will be.
To calculate the penalty, the government determines the number of full months you didn’t have coverage. That number is multiplied by 1 percent of the national base beneficiary premium. This premium can go up each year, meaning the penalty can increase. As of 2019, the premium is $33.19.
Going without prescription drug coverage is expensive. You will have to pay out-of-pocket costs and will be assessed a penalty if you decide to add coverage later. Don’t wait another minute to get coverage. Call 844-903-4406 to speak to a licensed insurance agent today.