Are Medicare Advantage Plans Guaranteed Issue?

Are Medicare Advantage Plans Guaranteed Issue?

Yes. If you qualify for medicare at age 65 and are enrolled in a medicare advantage plan, you will continue to be covered under the same plan until the end of the year.

Will my health plan cost more if I choose to stay with it instead of enrolling in a Part D Prescription Drug Plan?

In most cases, staying in your plan and paying the monthly premiums will cost you less than enrolling in a Part D plan. But you should contact your plan and any health care providers you plan to use to make sure you are getting the best deal.

Will Part D affect my Medicare Advantage plan?

No. As long as you are enrolled in a Medicare Advantage plan you will not have to join a Part D plan.

Am I eligible for Extra Help paying for my drugs?

To get this help, you must qualify for both Medicare and Medicaid, or qualify for Social Security Disability income (SSDI). You must also have limited income and assets, however, your spouse's assets will not affect your eligibility for Extra Help.

For more information about Extra Help, visit the Medicare website at www.medicare.gov or call 1-800-MEDICARE or 1-877-690-1012 (TTY).

How do I get help paying for my medications?

Whether you choose a stand-alone prescription drug plan, or choose to enroll in a Medicare Advantage plan with a prescription drug component, you may be eligible to get help paying your premiums and some or all of your drug costs. You may also be eligible for extra help with drug costs if you qualify for both Medicare and Medicaid, or qualify for Social Security Disability income (SSDI).

How do I enroll in Part D?

When you get your Medicare card in the mail, it will also include information about when you can enroll in a prescription drug plan. If you delay enrolling, you may have to pay a penalty.

You can enroll online or by phone, or sign up in person. To see how to enroll when you get your Medicare card, visit www.medicare.gov/prescriptionhelp/get-enrolled.html or call 1-800-MEDICARE or 1-877-690-1012 for the hearing and speech-impaired (TTY) and visit www.ssa.gov/prescriptionhelp for information on how to enroll in Part D for SSI beneficiaries.

What if I have a very low income?

If your income is less than 135 percent of the federal poverty level, you can ask your Part D plan to make a payment directly to your pharmacy. This is called Direct Pay. In many cases, a plan will pay out-of-pocket costs if you are paying out of pocket for your prescription drugs. If you want to sign up for Direct Pay, contact your plan to find out how to enroll.

If you are on Medicaid, you must enroll in a Part D plan to get help paying for your prescription drugs.

If you are not on Medicaid but still want help paying for your prescription drugs, you may be eligible for Medicaid. Your Social Security office can help you enroll in Medicaid.

What if I continue to work and my employer provides prescription drug insurance?

If you continue to work and your employer offers prescription drug coverage, you might be able to keep the coverage you already have, even if you enroll in a Part D plan.

What if I want to use the same doctor and pharmacy?

If you have a prescription drug plan now and want to stay with your doctor and pharmacy, you can. The only exception is with Medicare Advantage Prescription Drug plans, which may require you to use certain pharmacies.

Will I be able to keep my current prescription drug coverage?

If you have drug coverage from your current employer, or if you are on a spouse's or parent's plan, you may be able to keep that coverage. You will need to check with the plan administrator to find out if you can keep your current coverage. If you decide not to keep your current coverage, you will have to enroll in a Part D plan if you want help paying for your prescription drugs.

What if I don't get my Medicare card in the mail when I am supposed to?

The fastest way to get your card is to apply online. To do so, you will need to know your Social Security number, and your date of birth and zip code. If you do not have your card by the time you need to use your Medicare coverage, you may be able to get emergency services. For more information, visit www.medicare.gov or call 1-800-MEDICARE (1-877-690-1012) or, for the hearing and speech-impaired, 1-877-690-1012 (TTY).

Will my Part D prescription drug plan pay for my drugs if I am in a nursing home or other institution?

If you are in a skilled nursing facility or another institution that offers Part D coverage, you will have to enroll in the Part D plan that serves that institution.

Can a Part D plan refuse to cover some or all of my drugs?

Part D plans are required to cover a certain amount of drugs for their enrollees. This is called the "formulary" and it lists which drugs are covered. The formulary may change from year to year. Each Part D plan must offer at least one drug in every category. The plan can choose to cover more drugs than are required.

What is the "donut hole"?

After you and your plan spend a certain amount each year on covered prescription drugs (combined), you enter the "donut hole." In the donut hole, you will have to pay a larger share of the cost of your drugs. But you may be able to get help paying for these drugs. For more information, visit www.medicare

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