PART D ENROLLMENT

Medicare Part D West Virginia

When You Can Join

Turning 65

Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. 


Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.


Medicare Enrollment Periods-- For more enrollment periods and situations

Helping with the cost of prescription drugs--assisting low-income individuals with the costs of their Part D coverage.

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.


Changing plans later

You can change your Medicare Part D plan each year during the Medicare Open Enrollment Period from October 15 to December 7 unless you qualify for an exception. Coverage becomes effective starting January 1 of the following year.

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's network
  • Whether the drugs you use are on your plan's formulary
  • Whether you get Extra Help paying your Medicare Part D costs

Look for specific Medicare drug plan costs, and then call the plans you're interested in to get more details.

If you have limited income and resources, your state may help you pay for Part A and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.

WHAT IS MEDICARE PART D COVERAGE?

Medicare Part D helps pay for the prescription drugs you use. Medicare Part D coverage is not automatic. You decide whether to enroll in a Medicare Part D plan. If you delay signing up after you are first eligible, though, you may pay a penalty on your premium, unless you qualify for an exception.

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you're first eligible, and you don't have other creditable prescription drug coverage, or you don't get Extra Help, you'll likely pay a late enrollment penalty.

TWO WAYS TO GET DRUG COVERAGE

1.  Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

2.  Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

MEDICARE PART D OVERVIEW

In terms of the cost for Medicare Part D coverage, you are likely to pay a monthly premium, along with deductibles, copayments, and other out-of-pocket costs. Your Medicare Part D costs are determined by your prescription requirements, pharmacy preference, and eligibility for the Extra Help program. 


Medicare Extra Help assists low-income individuals with the costs of their Part D coverage. You can visit the Social Security website for additional information, including whether or not you qualify for special assistance.


Most Part D plans include a coverage gap, known also as the “donut hole.” The coverage gap refers to the point that you reach your plan’s initial coverage limit. Once you enter this donut hole, you pay the full cost of your prescriptions until the maximum out-of-pocket limit is reached, minus any applicable manufacturer discounts and government subsidies. 


Once that limit is reached, you enter the catastrophic coverage phase, at which point you will only pay a small coinsurance or copayment amount for the remainder of the year, while your Part D plan covers the rest. On January 1, initial coverage will reset for your prescription drug plan.


When deciding whether or not Part D coverage is necessary, it is recommended that you consider your current and future medication needs. Even if you do not currently need drug coverage, it is cheaper for you to enroll when you are first eligible. Delaying Part D enrollment means you will pay a late enrollment penalty if or when you decide to join down the line.

When to join a Part D plan


You may enroll in Medicare Part D when you first join Medicare Part A and/or Medicare Part B. You may also make changes to this coverage during the Annual Election Period (AEP) that occurs between October 15 and December 7 of each year. During AEP, you may change from one drug plan to another or drop prescription coverage entirely. Any changes made to drug coverage during AEP will go into effect on January 1 of the following year.

Medicare Part D donut hole

SERVICES NOT COVERED

Plans vary in which specific drugs they cover, and you won’t get help with the cost of a drug that is not covered by a plan. For example, a plan may cover only certain cholesterol-reducing drugs. If the specific cholesterol-reducing drug you take isn’t covered by a plan, the plan won’t help you with the cost of that drug.


The federal government also requires plans to exclude certain types of drugs from the plan entirely. Weight-loss drugs are one example. Some plans, called enhanced plans, do cover some of these types of drugs.


In most plans, there is a stage of cost sharing called the “coverage gap,” or the “doughnut hole.” In this stage you must pay most of the plan’s price for the medications you take.


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PHARMACIES

Each drug plan decides which pharmacies plan members may use. Plans may also limit your choice of pharmacies by geographic area, such as a state. Other plans offer nationwide coverage. If you travel often, you may want to consider a plan that allows you to access pharmacies wherever you go. 


Some plans also offer mail order services, so you can have drugs mailed to your home. Each Medicare Part D plan has a service area, or area where it operates. You must live in a plan’s service area to join it.

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