Medicare Part D

Medicare Part D is a voluntary prescription drug benefit and is offered by private companies that are approved by Medicare. Beneficiaries should sign up for a plan three months prior, the month of or three months after their 65th birthday. 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.

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.

What is the process for enrolling in a Part D plan?

Step 1 - Compare Plans
The North Dakota Insurance Department recommends three ways in which you can compare Medicare Part D plans prior to enrollment:

  • Contact the State Health Insurance Counseling (SHIC) program for a free drug plan comparison.
  • Attend a free SHIC enrollment event for one-on-one counseling.
  • Contact Medicare at (800) MEDICARE for a comparison or visit Medicare.gov to complete a self-guided comparison.
  • Call 2-1-1 from anywhere in North Dakota during open enrollment - after providing your medication information and answering some questions, information on the top three plans will be mailed to you

To complete a Medicare Part D plan comparison, you will need:

  • A list of your medications, including dosages and frequency
  • Your Medicare card
  • The full name of your current plan
  • A yellow drug retrieval card from the Department, if you are attending a SHIC enrollment event

To complete a self-guided comparison of Medicare Part D plans using Medicare.gov:

Begin Comparison

  • Visit www.Medicare.gov
  • Click the green box labeled “Find health & drug plans” - this will take you to a page titled, "Find a plant that works for you"
  • Enter your zip code in the box labeled "Basic Search" and click on the “Find Plans” button - this will take you to a page titled, "Step 1 of 4: Enter Information"
  • Select “Original Medicare” under "How do you get your Medicare coverage?"
  • Under "Do you get help from Medicare or your state to pay your Medicare prescription drug costs?" select the best answer to the question about your prescription costs
  • Select "Yes" under "Would you like to add drugs?"
  • Click "Continue to Plan Results" to continue - this will take you to a page titled, "Step 2 of 4: Enter Your Drugs"

Enter Medications
Enter each medication using the following directions or if you have a yellow drug retrieval card from the Department, simply enter the ID and password into the "Retrieve My Saved Drug List" box and click on the “Retrieve My Drug List” button:

  • Enter the name of your medication into the box provided under "Type the name of your drug" and click on the "Find My Drug" button or use the A-Z list - this will take you to a page with a list of medications that may match your search
  • Locate the correct medication and click “Add drug” - when prompted, select your current dosage, quantity and the frequency of which you take your medication then click “Add drug and dosage” button
  • Place the cursor back in “Type the name of your drug” box and enter your next medication until your list is complete, then click on “My Drug List is Complete” - this will take you to a page titled, "Step 3 of 4: Select Your Pharmacies"
  • Select your preferred pharmacy from the list of local pharmacies provided by clicking on “Add Pharmacy” directly under the correct pharmacy name, then click on the “Continue to Plan Results” button - this will take you to a page titled, "Step 4 of 4: Refine Your Plan Results" (if your preferred pharmacy is not listed, select more miles in radius from the drop-down menu at the top of the box)

Compare and Select a "Best Fit" Plan

  • Once you've reached the “Step 4 of 4: Refine Your Plan Results” screen, select the box for “Prescription Drug Plans (with Original Medicare)" then click on the “Continue to Plan Results” button - this will take you to a screen titled, "Your Plan Results"
  • There will be two sections on the "Your Plan Results" page -  “Your Current Plan(s)” section, which shows costs associated with your Original Medicare, and the “Prescription Drug Plans” section, which will be arranged in order beginning with the least expensive plan first (according to estimated annual drug costs)
  • Click on the name of the plan you wish to look at in more detail - this will bring you to a tab labeled, "Drug Costs & Coverage" to get an overview of the plan (should you wish to look at another plan, click on the gray button above labeled, "Return to previous page”
    • Review the “Fixed Costs” section that shows you the monthly premium you will pay as well as any deductible that might be required.
    • Review the "Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs" section and understand that included in the estimated cost shown for either January enrollment or enrollment today are all premiums paid, the deductible and the copays/coinsurance you will pay at the pharmacy - it essentially estimates your total out-of-pocket cost for that time frame
    • Review the “Drug Costs During Coverage Levels” section that shows the full cost of each drug, what you pay before your deductible (if any) is met, what you will pay during the initial coverage period (time before the donut hole), what you will pay if you go into the gap or donut hole, and what you would pay if entering the period after the gap or donut hole, referred to as catastrophic coverage
    • Review the “Estimated Monthly Drug Costs” graph that shows what you will most likely be paying on a monthly basis (includes your premium as well as costs of all medications) and shows you if/when you will enter the coverage gap or donut hole
    • Review the “Drug Coverage Information” section to determine if all of your medications are in the plan’s formulary (if not you may want to look at another plan because you could be paying 100 percent for those that are not), you will also be able to check if any of your medications require prior authorization or if there are quantity limits or step therapy requirements (you can find the definition for each restriction by clicking on the “?” beside each restriction)
  • Print the plans you wish to compare by clicking on the “Print Plan Report” tab under the “Drug Coverage Information” section
  • Repeat the review process for all plans you wish to compare

Step 2 - Select a Plan
Things to think about when selecting the right Medicare Part D plan for you:

  • Does my pharmacy accept this prescription drug plan?
  • Does the plan fit into my budget?
  • Are all my medications covered by the plan?
  • Does the plan have quantity limits or step therapy for any of my medications?

Beneficiaries should select the plan that best combines several factors:

  • Plan approval for Low-income Subsidy or Extra Help if applicable
  • A plan that includes all or most of your medications on its formulary
  • A plan with the fewest limitations such as step therapy or prior authorization
  • A plan with good cost structure based on current medications

Step 3 - Enroll in a Plan
The Department recommends four ways in which you can enroll in a Medicare Part D plan:

  • Contact SHIC
  • Contact Medicare
  • Contact the prescription drug plan you are interested in
  • Contact a life/health agent who sells the plan you are interested in

To complete a self-guided enrollment in a Medicare Part D plan using Medicare.gov, there are three options:

  • Click the “Enroll” button from the “Your Plan Details” page - this will take you to a page titled, "Medicare Health and Drug Plan Enrollment Center"
    • Enter your personal information
    • Keep the confirmation number given to you upon completion of a successful enrollment
  • Contact Medicare for assistance with enrollment
  • Contact the plan you selected directly by calling the “Non-Member” phone number listed on the "Your Plan Details" page

Step 4 - Utilize the Plan
Things to know after enrolling in a Medicare Part D plan:

  • Your Medicare Part D plan 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 during the annual enrollment period, the new plan will take effect Jan. 1 of the following year
Will my prescriptions be covered?

Each Medicare Part D plan will list the prescriptions that are covered under that plan; this list is called a formulary. The simplest method of determining if your drugs are covered is by using the Medicare Plan Finder or by contacting the State Health Insurance Counseling (SHIC) program for a comparison.

Can the formulary on a Medicare Part D plan change?

The formulary, which is a list of the prescription drugs covered by a plan, can and do change. Companies must give beneficiaries at least 60 days notice of a change.

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.

Do Medicare Advantage Plans offer drug coverage?

In certain Medicare Advantage Plans, prescription drugs are covered. However, remember that these plans are not appropriate for everyone.

What are the Extra Help/Low-income Subsidy (LIS) income guidelines?

A Social Security program called Low-income Subsidy (LIS) may help pay your Medicare premiums and drug costs. Contact the Social Security Administration or the State Health Insurance Counseling (SHIC) program to apply for a low-income subsidy.