US Healthcare: Medicare Part D

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US Healthcare: Medicare Part D
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2/14/2011: Medicare Part D
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  1. What is Medicare prescription drug coverage (Part D)?
    Medicare prescription drug coverage (Part D) is coverage that adds to, or is included with, your Medicare health care coverage. It helps you pay for both the brand-name and generic drugs you need. Medicare drug plans are offered by insurance companies and other private companies approved by Medicare.
  2. What are the two ways to get Medicare Prescription Drug Coverage?
    • Medicare Prescription Drug Plans (sometimes called PDPs) add prescription drug coverage to Original Medicare, some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans, and Medicare Medical Savings Account (MSA) Plans.
    • Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer prescription drug coverage. You generally get all of your Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and Part D coverage through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”
  3. Why should I consider joining a Medicare drug plan?
    Everyone with Medicare has a decision to make about prescription drug coverage. If you don’t use a lot of prescription drugs now, you still should consider joining a Medicare drug plan. This coverage may help lower your prescription drug costs and help protect against higher costs in the future. If you are new to Medicare and have prescription drug coverage now, you have new choices to consider.
  4. Who is eligible for Medicare Part D?
    To join a Medicare Prescription Drug Plan, you must be entitled to Medicare Part A (Hospital Insurance) and/or have Medicare Part B (Medical Insurance). To join a Medicare Advantage Plan or other Medicare health plan with prescription drug coverage, you must have Medicare Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.
  5. What does Medicare Part D cover?
    Medicare drug plans vary in what prescription drugs they cover, how much you have to pay, and which pharmacies you can use. All Medicare drug plans must provide at least a standard level of coverage set by Medicare. However, plans offer different combinations of coverage and cost sharing. Having a variety of plans to choose from gives you the chance to pick a plan that meets your needs. Choosing a plan that fits your situation allows you to get the coverage you want at the best price possible.
  6. What happens if I am eligible for Part D, but I don't sign up?
    If you decide to join a Medicare drug plan, compare plans in your area and choose one that meets your needs. If you don’t join a Medicare drug plan when you are first eligible for Medicare, and you don’t have drug coverage that is, on average, expected to pay at least as much as standard Medicare prescription drug coverage (called creditable prescription drug coverage), you may have to pay a late enrollment penalty if you join later. The penalty is in addition to your premium each month for as long as you have a Medicare drug plan.
  7. How is Part D coverage different from the coverage Part B provides for certain drugs?
    Part B provides limited prescription drug coverage. Part B covers certain drugs, such as certain injectable, cancer, and immunosuppressive drugs. You pay coinsurance, and the Part B deductible applies. Part B also covers the flu and pneumococcal vaccines. Generally, Medicare drug plans cover vaccines (like the shingles vaccine) that aren’t covered under Part B when the vaccine is needed to prevent illness.

    Note: Generally, self-administered drugs you get in an outpatient setting (like an emergency room, observation unit, surgery center, or pain clinic) aren’t covered by Medicare Part A or Part B. Your Medicare drug plan may cover these drugs under certain circumstances. You may need to pay out-of-pocket for these drugs and contact your plan to get back some of the cost. Call your plan for more information.
  8. Is there help available as I consider all my options in choosing a prescription drug plan?
    You can get help comparing or joining Medicare drug plans:

    ■ Visit www.medicare.gov to get personalized information. Select “Compare Medicare Prescription Drug Plans” or “Compare Health Plans and Medigap Policies in Your Area.” These tools can help you find which plans in your area cover your prescriptions and which pharmacies you can use to fill prescriptions.

    ■ Call your State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling.

    ■ Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

    Note: As you consider the plans available to you, remember that companies are allowed to mail you information, but plans can’t call you unless you are already a member of the plan. Companies aren’t allowed to sell plans door-to-door unless you ask them to come to your home to help you. Remember to keep your personal information safe.
  9. What kind of payments will I be expected to make for coverage on a Medicare plan?
    Payments you may make in a Medicare drug plan include the following:

    • Monthly premium—Most drug plans charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you belong to a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that includes Medicare prescription drug coverage, the monthly premium for that plan may include an amount for prescription drug coverage.
    • Yearly deductible—This is the amount you pay for your prescriptions before your plan begins to pay. Some plans charge no deductible.
    • Copayments or coinsurance—You pay these amounts for your prescriptions after you pay the deductible. You pay your share and your plan pays its share for covered drugs.
  10. I have heard of the so-called "donut hole" with Part D. What is that?
    Coverage gap—Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit). Your yearly deductible, coinsurance or copayments, and what you pay in the coverage gap all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.

    There are plans that offer some coverage during the gap, like for generic drugs. However, plans with gap coverage may charge a higher monthly premium. Check with the plan first to see if your drugs would be covered during the gap.

    Catastrophic coverage— Once you reach your plan’s out-of-pocket limit during the coverage gap, you automatically get “catastrophic coverage.” Catastrophic coverage assures that once you have spent up to your plan’s out-of-pocket limit for covered drugs, you only pay a small coinsurance amount or a copayment for the rest of the year.

    Note: If you get extra help paying your drug costs, you won’t have a coverage gap and will pay a small or no copayment once you reach catastrophic coverage.
  11. Give me an example of a plan that has a coverage gap.
    Mr. Jones joins the ABC Prescription Drug Plan. His coverage begins on January 1, 2009. He pays the plan a monthly premium throughout the year, even during his coverage gap. He doesn’t get extra help and uses his Medicare drug plan membership card when he buys prescriptions.

    Monthly Premium— Mr. Jones pays a monthly premium throughout the year.

    • 1. Yearly Deductible
    • Mr. Jones pays the first $295 of his drug costs before his plan starts to pay its share.

    • 2. Copayment or Coinsurance
    • Mr. Jones pays a copayment for each prescription, and his plan pays its share for each covered drug until what they pay (plus the deductible) reaches $2,700.

    • 3. Coverage Gap
    • Once Mr. Jones and his plan have spent $2,700 for covered drugs, he is in the coverage gap. He will have to pay all of his drug costs until he has spent $4,350.

    • 4. Catastrophic Coverage
    • Once Mr. Jones has spent $4,350 out-of-pocket for the year, his coverage gap ends. Now he only pays a small coinsurance amount or copayment (like $6) for each drug until the end of the year.
  12. How can I pay my Medicare Drug plan premium?
    In general, there are four ways you can pay your Medicare drug plan premiums:

    • 1.Deducted from your checking or savings account.
    • 2.Charged to a credit or debit card.
    • 3.Billed to you each month directly by the plan. (Some plans bill in advance for coverage the next month.)
    • 4.Withheld from your Social Security payment. Contact your plan (not Social Security) to ask for this payment option. If you choose this option, your first 2 months of premiums will be combined.
  13. When can I join, switch or drop a drug plan?
    You can join, switch, or drop a Medicare drug plan at these times:

    • When you first become eligible for Medicare. You can join 3 months before you turn age 65 to 3 months after the month you turn age 65.
    • If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability.
    • Between November 15–December 31 each year. Your coverage will begin on January 1 of the following year as long as the plan gets your request for enrollment by December 31.
    • At any time if you qualify for extra help. This includes people who have Medicare and Medicaid, belong to a Medicare Savings Program, get Supplemental Security Income (SSI) benefits, and those who apply and qualify.

    Note: In certain limited circumstances, you may be able to switch to another Medicare drug plan. For example, you may be able to switch at other times if you permanently move out of your drug plan’s service area, lose creditable prescription drug coverage, or if you enter, live in, or leave a nursing home.

    If you currently have Medicare prescription drug coverage, you should review your coverage each year in the fall. If you are happy with your coverage, cost, and customer service, and your Medicare drug plan is still offered in your area, you don’t have to do anything for your coverage to continue for another year. However, if you decide another plan will better meet your needs, you can switch to a different plan.
  14. How do I avoid paying a penalty?
    Join a Medicare drug plan when you’re first eligible. You won’t have to pay a penalty, even if you’ve never had prescription drug coverage before.

    Don’t go for more than 63 days without a Medicare drug plan or other creditable coverage. Creditable coverage could include drug coverage from a former employer or union, TRICARE, or the VA. You should get a notice every year telling you whether the drug coverage you have is creditable coverage. Keep this notice, because you may need it if you join a Medicare drug plan later.

    Let your Medicare drug plan know when you join if you have other creditable coverage. You may get a letter from your plan asking if you have creditable coverage. Complete the form they give you if you do. If you don’t tell your plan about your creditable coverage, you may have to pay a penalty.
  15. What if I need to fill a prescription before I get my membership card?
    • About a week after you join a plan, you will get a letter from the plan letting you know they got your information. Three to five weeks later, you should get a welcome package with your membership card. If you need to go to the pharmacy before your membership card arrives, you can use any of the following as proof of membership in your Medicare drug plan:
    • An acknowledgement, confirmation, or welcome letter from the plan.
    • An enrollment confirmation number from the plan and the plan name and telephone number.
  16. What if I’m taking a drug that isn’t on my plan’s drug list when my drug plan coverage begins?
    Your drug plan will provide a one-time, temporary 30-day supply of your current drug during your first 90 days in a plan. Plans are required to give you this temporary supply so that you and your doctor have time (30 days) to find another drug on the plan’s drug list that will work as well as the drug you are taking now. Different rules may apply for people who move into or already live in an institution (such as a nursing home or long-term care hospital).

    However, if you have already tried similar drugs on your plan’s drug list and they didn’t work, or if your doctor determines that you need a certain drug because of your medical condition, you or your doctor can contact your plan to request an exception as soon as you get your temporary 30-day supply. You can also request an exception if your doctor thinks you need to have a coverage rule waived, such as a quantity limit. If you or your doctor’s request is approved, the plan will cover the drug. If your plan doesn’t approve the exception, you can appeal the plan’s decision.
  17. What is a Medicare Cost Plan?
    Medicare Cost Plan—A type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan’s network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services or urgently-needed services).
  18. What is a Medicare Health Maintenance Organization (HMO)?
    Medicare Health Maintenance Organization—A type of Medicare Advantage Plan (Part C) available in some areas of the country. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. Most HMOs also require you to get a referral from your primary care physician.
  19. What is a Medical Savings Account (MSA) Plan?
    Medicare Medical Savings Account (MSA) Plan—MSA Plans combine a high deductible Medicare Advantage Plan and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount so you generally will have to pay out-of-pocket before your coverage begins.
  20. What is a Medicare Preferred Provider Organization (PPO) Plan?
    Medicare Preferred Provider Organization (PPO) Plan—A type of Medicare Advantage Plan (Part C) available in some areas of the country in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
  21. What is Medicare Prescription Drug Plan (Part D)?
    Medicare Prescription Drug Plan (Part D)—A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
  22. What is a Medicare Private Fee-for-Service (PFFS) Plan?
    Medicare Private Fee-for-Service (PFFS) Plan—A type of Medicare Advantage Plan (Part C) in which you can generally go to any doctor or hospital you could go to if you had Original Medicare, if the doctor or hospital agrees to treat you. The plan determines how much it will pay doctors and hospitals, and how much you must pay when you get care. A Private Fee-For-Service Plan is very different than Original Medicare, and you must follow the plan rules carefully when you go for health care services. When you’re in a Private Fee-For-Service Plan, you may pay more, or less, for Medicare-covered benefits than in Original Medicare.
  23. What is Medigap Policy?
    Medigap Policy—Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage. Some Medigap policies sold before January 1, 2006, have prescription drug coverage. Policies sold on or after January 1, 2006, don’t have prescription drug coverage.
  24. What is Original Medicare?
    Original Medicare—Original Medicare is the fee-for-service plan under which the government pays your health care providers directly for your Part A and/or Part B benefits.
  25. What is a Penalty?
    Penalty—An amount added to your monthly premium for Medicare Part B or a Medicare drug plan (Part D), if you don’t join when you’re first eligible. You pay this higher amount as long as you have Medicare. There are some exceptions.
  26. What is a Premium?
    Premium—The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
  27. What is State Health Insurance Assistance Program (SHIP)?
    State Health Insurance Assistance Program (SHIP)—A state program that gets money from the Federal government to give free local health insurance counseling to people with Medicare.
  28. What is State Pharmacy Assistance Program (SPAP)?
    State Pharmacy Assistance Program (SPAP)—A state program that provides help paying for drug coverage based on financial need, age, or medical condition.
  29. What is another name for Part D?
    PDP = Prescription Drug Plan
  30. What is Part A (Hospital Insurance)?
    Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

    Most people don’t pay a Part A premium because they paid Medicare taxes while working. This is called "premium-free Part A." Some people automatically get Part A this way.

    • If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:
    • 1) You're 65 or older, you're entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.
    • 2) You're under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)

    In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income/resources, your state may help you pay for Part A and/or Part B.

    • In general, Part A covers:
    • 1) Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
    • 2) Inpatient care in a skilled nursing facility (not custodial or long term care)
    • 3) Hospice care services
    • 4) Home health care services
    • 5) Inpatient care in a Religious Nonmedical Health Care Institution

    Note: Staying overnight in a hospital doesn’t always mean you’re an inpatient. You’re considered an inpatient the day a doctor formally admits you to a hospital with a doctor’s order. Being an inpatient or an outpatient affects your out-of-pocket costs. Always ask if you’re an inpatient or an outpatient.
  31. What is Part B (Medical Insurance)?
    Part B helps cover medically-necessary services like doctors' services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

    If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty. Some people automatically get Part B.

    • To find out if Part B covers something specific, visit Your Medicare Coverage. In general, Part B covers two types of services:
    • 1) Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
    • 2) Preventive services — Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
  32. What is a Medicare Advantage Plan (Part C)?
    A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

    If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

    Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

    • Different types of Medicare Advantage Plans:
    • 1) Health Maintenance Organization (HMO) Plans
    • 2) Preferred Provider Organization (PPO) Plans
    • 3) Private Fee-for-Service (PFFS) Plans
    • 4) Special Needs Plans (SNP)

    • There are other less common types of Medicare Advantage Plans that may be available:
    • 1) HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
    • 2) Medical Savings Account (MSA) Plans—A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

    • The cost of a Medicare Advantage Plan:
    • In addition to your Part B premium, you usually pay one monthly premium for the services included.

    • Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:
    • 1) Whether the plan charges a monthly premium.
    • 2) Whether the plan pays any of your monthly Part B premium.
    • 3) Whether the plan has a yearly deductible or any additional deductibles.
    • 4) How much you pay for each visit or service (copayments or coinsurance).
    • 5) The type of health care services you need and how often you get them.
    • 6) Whether you follow the plan’s rules, like using network providers.
    • 7) Whether you need extra benefits and if the plan charges for them.
    • 8) The plan’s yearly limit on your out-of-pocket costs for all medical services.

    • The coverage of a Medicare Advantage Plan:
    • In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

    • How to get a Medicare Advantage Plan:
    • Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plans website. Medicare also has information on quality to help you compare plans.

    • Other Information about a Medicare Advantage Plan:
    • New—Making changes to your coverage after December 31
    • Between January 1–February 14, 2011, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

    • During this period, you can’t do the following:
    • 1) Switch from Original Medicare to a Medicare Advantage Plan.
    • 2) Switch from one Medicare Advantage Plan to another.
    • 3) Switch from one Medicare Prescription Drug Plan to another.
    • 4) Join, switch, or drop a Medicare Medical Savings Account Plan.

    • A few extra things about a Medicare Advantage Plan:
    • 1) As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
    • 2) Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
    • 3) You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
    • 4) You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
    • 5) You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.
    • 6) If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
    • 7) If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.
  33. What is Part D (Medicare Prescription Drug Coverage)?
    Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare.

    • There are two ways to get Medicare prescription drug coverage:
    • 1) Medicare Prescription Drug Plans. 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 Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs."

    If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.

    • How Much Does Medicare Prescription Drug Coverage Cost?
    • Each plan can vary in cost and drugs covered. The Medicare Drug Plan Finder can help you find and compare plans in your area.Your Part D monthly premium could be higher based on your income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium. For more information, visit Social Security’s website.

    Many people qualify to get Extra Help paying their Medicare prescription drug costs but don’t know it. Most who qualify and join a Medicare drug plan will get 95% of their costs covered. Don’t miss out on a chance to save. Extra Help and other programs (like Medicare Savings Programs) may help make your health care and prescription drug costs more affordable.

    • How Do I Get Medicare Prescription Drug Coverage?
    • To join a Medicare Prescription Drug Plan, you must have Medicare Part A or Part B. To join a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.

    Remember, costs and coverage varies with each plan. Check out theMedicare Drug Plan Finder can help you find and compare plans in your area. Medicare also has information on quality to help you compare plans.

    If you have employer or union coverage, call your benefits administrator before you make any changes, to before you sign up for any other coverage. If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health (doctor and hospital) coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependants.

    Once you choose a Medicare drug plan, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan’s Web site or on the Medicare Drug Plan Finder. You can also enroll by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1‑877-486-2048. When you join a Medicare drug plan, you will have to provide your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card. Note: Medicare drug plans aren’t allowed to call you to enroll you in a plan. Call 1-800-MEDICARE to report a plan that does this.

    • How Does My Other Insurance Work with Medicare Drug Coverage?
    • If you have other insurance, find it below to understand how it works with, or is affected by, Medicare prescription drug coverage.

    • Employer or Union Health Coverage
    • This is health coverage based on your, your spouse’s, or other family member's current or former employment. If you have prescription drug coverage based on employment, the employer or union will notify you each year to let you know if your drug coverage is creditable. Keep the information you get. If you join a Medicare drug plan, you, your spouse, or your dependants may lose your employer or union health coverage. Call your benefits administrator for more information before making any changes to your coverage.

    • COBRA
    • This is a Federal law that may allow you to temporarily keep employer or union health coverage after the employment ends or after you lose coverage as a dependent of the covered employee.

    There may be reasons why you should take Part B instead of COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you will have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends. Talk with your State Health Insurance Assistance Program (SHIP) to see if COBRA is a good choice for you.

    • Medigap (Medicare Supplement Insurance) Policy with Prescription Drug Coverage
    • Medigap policies are no longer sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. But you may want to join a Medicare drug plan instead, because most Medigap drug coverage isn’t creditable. If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.

    The types of insurance listed below are all considered creditable prescription drug coverage. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.

    • Federal Employee Health Benefits Program (FEHBP)
    • If you join a Medicare drug plan, you can keep your FEHBP plan, and your plan will let you know who pays first. For more information, contact the Office of Personnel Management at 1-888-767-6738, or visitthe Office of Personnel Management website. TTY users should call 1-800-878-5707. You can also call your plan if you have questions.

    • Veterans Benefits
    • You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription. For more information, call the VA at 1-800-827-1000, or visit the VA website. TTY users should call 1-800-829-4833.

    • TRICARE (Military Health Benefits)
    • Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you aren’t required to join a Medicare drug plan. If you do, your Medicare drug plan pays first, and TRICARE pays second. If you join a Medicare Advantage Plan with prescription drug coverage, TRICARE won’t pay for your prescription drugs. For more information, call the TRICARE pharmacy contractor at 1 877 363 8779, or visit the TRICARE website. TTY users should call 1-877-540-6261.

    • Indian Health Services
    • If you get prescription drugs through an Indian health pharmacy, you pay nothing and your coverage won’t be interrupted. Joining a Medicare drug plan may help your Indian health provider with costs, because the drug plan pays part of the cost of your prescriptions. Talk to your benefits coordinator - they can help you choose a plan that meets your needs and explain how Medicare works with your health care system.

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