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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 Guide

Part 1: How Medicare Part D Works

Understanding the basics

If I sign up for a plan, how can I be sure I’ll get my meds on day one of coverage?

Signing up during the first two weeks of the month will give the plan time to process paperwork, issue your ID card and get your details into the pharmacy computer system before your coverage begins on the first day of the following month. If the details haven’t been uploaded into the system, have the pharmacist call your plan for confirmation of your membership.

I paid full price at the pharmacy because my enrollment in a Medicare drug plan wasn’t recorded in the system. Can I get a refund?

Yes. Save your receipt and contact your plan about the refund process. (If you’ve lost your receipt, your pharmacist can probably provide a duplicate.)

How can I keep track of my drug spending?

Your plan must send you a monthly statement.

Can my plan’s charges change after I enroll?

The premium and deductible cannot change between Jan. 1 and Dec. 31. A copay may change if a drug is moved to another tier of charges. But your plan cannot charge you a higher copay than the one you first paid for the same drug during the calendar year.

Plans can change the “full price” of their drugs on a weekly basis during the year. This can affect your payments in the deductible period and the coverage gap, and also if your plan charges coinsurance (a percentage of the cost) in the initial coverage period for any drugs. It will not affect you in the initial coverage period if you pay a fixed amount (copay) for each prescription.

Plans can change all charges every calendar year. Any changes go into effect Jan. 1.

How often can I switch drug plans?

You can normally change plans only once a year during annual open enrollment, which runs from Oct. 15 to Dec. 7.

There are exceptions. In some circumstances—for example, if you move out of your plan’s area or your plan ceases services in your area, or you move into or out of a nursing home—you’re entitled to a special enrollment period (SEP) so that you can change drug plans during that time. People with limited incomes who receive Extra Help can switch to another plan at any time during the year.  For a full list of circumstances, see the Medicare Rights Center’s guidance on special enrollment periods.

What if I live in the U.S. territories?

You can join the Part D program but may have fewer Medicare drug plans to choose from. Also, the Extra Help program is different in the territories. To find out whether you qualify for financial assistance paying for prescription drugs in:

Puerto Rico: Call the Medicare Platino program at 787-294-8060 or toll free at 866-596-4747.

U.S. Virgin Islands: Call 340-774-4624 in St. Thomas or St. John, or 340-773-1311 in St. Croix.

All other territories: Call the Medicare help line at 800-633-4227

Patricia Barry writes the AARP Ask Ms. Medicare column and is the author of  Medicare for Dummies (Wiley/AARP, October 2013).

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