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Home : SHIC : Medicare Part D FAQs
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Medicare Part D FAQs
What is Part D?
How much are the premiums for these Part D plans?
Will my prescriptions be covered?
Can the formularies on Part D plans change?
What is the Part D donut hole or coverage gap?
When can people sign up for a Part D plan?
What is the process for enrolling in a Part D plan?
Do Medicare Advantage Plans offer drug coverage?
What are the Extra Help/LIS income guidelines for 2011?
How do I apply for LIS?
What is Part D?
Medicare Part D is a voluntary prescription drug benefit and is offered by private companies which are approved by Medicare. In 2011, there are 33 plans available in North Dakota.
How much are the premiums for these Part D plans?
Costs for these plans start at $14.80. Thirteen plans have $0 deductibles.
Will my prescriptions be covered?
Each Part D plan will list the prescriptions that are covered under the plan; this list is called a formulary. The simplest method of determining if your drugs are covered is by using the planfinder on Medicare's website or by contacting the State Health Insurance Counseling Program at 1.888.575.6611 for a comparison.
Can the formularies on Part D plans change?
The formularies, which are lists of the prescription drugs covered, can change. The companies must give the beneficiaries at least 60 days notice of change.
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What is the Part D donut hole or coverage gap?
Medicare drug plans may have a coverage gap which is sometimes called the donut hole.' A coverage gap means that after you have spent a certain amount of money for covered drugs; the beneficiary will have to pay all the costs for the drugs while in the gap. This amount does not include the plan's monthly premium. Once the beneficiary has reached the out-of-pocket limit, then catastrophic coverage begins.
When can people sign up for a Part D plan?
Beneficiaries should sign up for a plan three months prior, the month of or three months after their 65th birthday. If a person continues to work after age 65 and has creditable coverage, they may not have to take a Part D plan until retirement.
If you receive Medicare due to a disability, you can join from three months before to three months after your 25th month of disability payments.
A delay in signing up may cause a penalty.
Each year, during the annual enrollment period from Oct. 15-Dec. 7, beneficiaries can change plans. It is important to review Part D plans annually to make sure beneficiaries are enrolled in the most appropriate plan.
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What is the process for enrolling in a Part D plan?
1. Compare a plan:
Contact the State Health Insurance Counseling Program at 1.888.575.6611 to have them run a free drug plan comparison
Visit Medicare's website to do one yourself or call 1.800.MEDICARE.
2. Select a plan: things to ask yourself:
Does my pharmacy accept this prescription drug plan? Call your pharmacist to verify.
Does the plan that is the best for me fit into my budget?
Are all my medications covered by the plans?
Does the plan have quantity limits or step therapy for any of my medications?
3. Enroll in a plan:
Call 1.800.633.4227 or 1.800.MEDICARE.
Call the prescription drug plan. These phone numbers are listed in the current issue of Medicare and You.
Contact a life/health agent who sells the plan.
Contact the State Health Insurance Counseling Program at 1.888.575.6611.
4. Utilize the plan:
The Medicare PDP usually becomes effective the month after you apply.
A plan membership card will be sent to you from the drug plan. Show this to the pharmacist when you purchase a prescription.
Each year, everyone in a prescription drug plan should have a plan comparison completed between Oct. 15 and Dec. 7, the annual enrollment period. The new plan will take effect Jan. 1 of the following year.
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Do Medicare Advantage Plans offer drug coverage?
In certain Medicare Advantage plans, prescription drugs are covered. However, remember that these MA plans are not appropriate for everyone. Click here to read about Medicare Advantage plans.
What are the Extra Help/LIS income guidelines for 2011?
A Social Security program called Low-Income Subsidy (LIS) may help pay your Medicare premiums and drug costs.
2011 income guidelines
Single: 16,335
Couple: $22,065
Your assets cannot exceed:
Single: $12,640
Couple: $25,260
How do I apply for LIS?
Contact the Social Security Administration at 1.800.772.1213 or the State Health Insurance Counseling Program at 1.888.575.6611 to apply for low income subsidy.
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