Do I Need Medicare Part D?

Do I Need Medicare Part D?

Part D is Medicare's prescription drug coverage. It works differently than Medicare Part A and Part B. If you want to enroll, you need to be on Medicare and have what's called "creditable" drug coverage from another source.

You can have Medicare Parts A and B, and your employer, union or other group health plan, or the plan of your spouse's employer, union or other group health plan may provide drug coverage.

Your Part D coverage will be limited to the expenses that your other drug coverage doesn't pay.

You can also have creditable drug coverage from the current medical or drug coverage you have or had from the Department of Veterans Affairs (VA), the Federal Employees Health Benefits Program (FEHBP), or the U.S. military.

What is "creditable" coverage?

Creditable coverage means that the plan paid at least a minimum amount toward the cost of prescription drugs.

You can check the "Summary of Benefits" you get from your plan to find out if your plan pays at least a minimum amount. The "Creditable Coverage Worksheet" from Social Security will also tell you if your plan is creditable.

Don't be confused if you don't have a "Summary of Benefits." All group health plans must supply one, but some plans, like a group health plan of a small employer, may choose to provide this information in other ways.

If you're still not sure about your coverage, call Social Security at 1-877-690-1012 (TTY 1-877-690-1012).

And remember: Don't stop taking your drugs until you check with Social Security and Medicare!

What's the deal with "medigap" plans?

Medicare Part D insurance is only for drugs that are not covered by your other drug plan (or plans).

If you already have creditable drug coverage from another source (like an employer, union or other group health plan, or the plan of your spouse's employer, union or other group health plan), don't enroll in Part D. If you already have creditable drug coverage from the current medical or drug coverage you have or had from the VA, the FEHBP or the U.S. military, don't enroll in Part D.

If you have a Medigap policy, you won't need Part D. Medigap plans are sold by private insurance companies and cover some or all of your costs for Medicare-covered drugs. In most states, you can buy any Medigap plan you want, even if you have Medicare Part A and Part B.

You can still buy a Medigap plan after you become eligible for Medicare Part D.

To learn more about Medigap, visit the website of the Medicare Rights Center at www.medicarerights.org or call the Medicare Rights Center Hotline at 1-877-690-1012.

Who should enroll in Part D?

Even if your drug coverage is creditable, you should enroll in Part D if you get prescription drug coverage through:

Medicare Advantage plans,

State prescription assistance programs (also called "low income programs"), or

Private prescription drug plans.

If you enroll in Part D when you can get your drugs for free, you may have to pay back some of your drug costs when you go back to creditable coverage. This is called "repaying."

If you're not sure if you have creditable coverage, call Social Security at 1-877-690-1012 (TTY 1-877-690-1012).

How do I enroll in Part D?

You can enroll in Part D any time during the year. If you don't enroll when you're first eligible, you can get retroactive Part D coverage back to the first of the month you were first eligible.

If you already get Social Security, Railroad Retirement Board, or Department of Veterans Affairs benefits, you should automatically get a Part D enrollment notice.

You can also enroll in Part D by:

Going to the Social Security website at www.socialsecurity.gov/medicare/prescription/partD/enroll.htm, or

Calling Social Security at 1-877-690-1012 (TTY 1-877-690-1012) 7 a.m. to 7 p.m. Monday through Friday.

What does Part D cost?

You don't pay a premium for Part D. But you may have to pay a deductible and a monthly premium. The deductible is a yearly amount you pay before you pay for your drugs. The premium is the amount you pay each month to stay in the Part D plan.

You don't have to pay anything if your income is below a certain level. Social Security will tell you the income level when you enroll in Part D.

You pay for Part D the same way you pay for Medicare Part B.

You pay a monthly premium based on your income.

You pay a yearly deductible based on your income.

For more information, see "How Can I Pay for Part D?

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You also pay for your drugs. If you have a "stand-alone" Part D plan, you pay the full cost of your medications.

If you have Medigap, you may pay less for your drugs, but you'll still pay for them.

You can also buy a Medicare Advantage plan that has Part D drug coverage. The monthly premium for a Medicare Advantage plan that has Part D coverage is more than a Part D "stand-alone" plan.

In some states that offer it, you can buy a prescription drug plan called a "Prescription Drug Plan" (

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