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the medicare drug plan
6 Key Facts

1. Anyone on Medicare can get coverage regardless of income or health.

2. You are not obligated to enroll, but there may be consequences if you don't sign up when you are first eligible to do so.

3. To get Medicare drug coverage, you must select one approved private drug plan among many offering different choices. There is no single government plan.

4. Is your income limited? If you qualify for a part of the program known as "Extra Help." you'll pay very little for your medications.

5. Are your drug costs very high? You'll pay no more than 5 percent of the cost of each prescription after you've spent a certain amount of money out-of-pocket in any one year.

6. Do you have better drug coverage already? You probably won't need Medicare's Part D coverage. But it's wise to check.

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Medicare Prescription Drug Coverage Plan

Part 4: Do You Need Medicare Part D?

Considering all your options

  • When you return to the United States after living abroad. You cannot receive Medicare drug coverage when you’re living abroad, but you can join Part D when you return to live in this country permanently. If you turned 65 when you were living abroad, you get a seven month initial enrollment period to join a Part D plan without penalty, starting three months before the month of your return and ending three months after it. Or, if you turned 65 before leaving the United States to live abroad, you get a special Part D enrollment period on your return, and will not pay a late penalty provided that you begin receiving Medicare drug coverage within 63 days of the date of your return.

  • When you’re released from prison. You cannot receive Medicare drug coverage while in prison or in any other correctional facility, but you can join Part D when you come out. If you turned 65 while inside, you get a seven-month enrollment period to join a Part D plan without penalty, starting three months before the month of your release and ending three months after it. Or, if you turned 65 before going to prison, you get a special enrollment period after coming out, and will not pay a late penalty provided that you begin receiving Medicare drug coverage within 63 days of your release.

  •  If you receive Extra Help, you won’t face a late penalty.

What if I already have drug coverage from my job or retiree benefits? What will happen when I become eligible for Medicare?

Your current or former employer or union must tell you if your present drug coverage will change when you become eligible for Medicare. This also applies to your spouse if he or she is covered under your employer health plan and becomes eligible for Medicare. Among their options, employers can:

  • Continue your current coverage. If so, check to see if it is as good as Medicare's.

  • Offer coverage through a specified Medicare drug plan. You must enroll in this to keep your employer’s coverage.

  • Offer drug coverage that adds to Medicare by paying some or all of your out-of-pocket Part D expenses.

  • Drop coverage — maybe helping toward the cost of your Medicare drug premiums or giving no help at all.

How do I tell if my current coverage is better or worse than Medicare's?

Your employer, union or any other third party that helps pay for your drugs should inform you before your 65th birthday whether your coverage is “creditable” — that is, considered at least as good as the standard Medicare drug benefit. If you don’t receive this information, call and ask for it in writing.

If your coverage is creditable, you need do no more. Even so, if your income is limited enough to qualify for Extra Help, compare those benefits with what you have now.

If your coverage is not creditable, you can still keep it. But if you sign up for a Medicare drug plan at some future date, and you have gone for more than 63 days without creditable coverage, you would then pay a late penalty.

Are there any risks involved in enrolling in Part D when I already have drug coverage?

Yes. Most employer or union prescription drug coverage comes as part of a health benefits package. If you join a Medicare drug plan and drop your current drug coverage, you might also lose coverage for your medical services and you may not be able to get those benefits back. If you have dependents on your policy, their coverage may be affected also. Contact your employer or union benefits administrator to make sure of the consequences before you make any decisions.

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