Medicare prescription drug coverage is an optional benefit offered to everyone who has Medicare. If you decide not to get Medicare Part D when you’re first eligible, you will likely pay a late enrollment penalty if you join later.
There are two ways you can get drug coverage:
- Medicare Prescription Drug Plan (Part D). These plans 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.
- Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. NOTE: If you are just starting Medicare since beginning dialysis, then a Medicare Advantage Plan will not be an option, it is only available if you started the plan prior to starting dialysis.
When can you get or change your Medicare Part D?
- Initial Enrollment Period: starts three months before you are eligible and lasts for seven months.
- Annual Enrollment Period: Oct. 15 – Dec. 7
- During open enrollment you can pick a plan, check for cost changes, and changes in your plan’s formulary (list of drugs covered).
To find the plan that is right for you check out “Plan Finder” at: httpss://www.medicare.gov/find-a-plan/questions/home.aspx or contact your state’s Health Insurance Program listed below.
Tip: Have your list of medications handy when you use the Plan Finder. It can show you the costs for each plan.
What will it cost? 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
Tip: Make sure to tell anyone helping you find a plan that you are a dialysis patient.
State Health Insurance Program:
Senior Health Insurance Program (SHIP)
Illinois Department on Aging