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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 6: Signing Up for a Part D Drug Plan

How to enroll and avoid hard sells

Can I be turned down?

Only in a few circumstances — for example, if you’re not eligible for Medicare, don’t live in the service area of the plan you’re applying to join or try to enroll outside a time period to which you are entitled. The plan must give a reason for denying your enrollment. If you’re denied but think you’re eligible, call Medicare immediately at 1-800-633-4227.

How will I know if my enrollment has been accepted or denied?

Within 10 calendar days of receiving your application, the plan must send you one of the following:

  • An acknowledgment of your completed application, a copy of it, and details of the plan’s costs and benefits; or
  • A request for more information to complete the application; or
  • A notice saying your application has been denied and the reasons why.

If you receive only the first of these, your enrollment will probably soon be confirmed and the plan will send your membership card and a document known as Evidence of Coverage which explains details of your coverage and its conditions. If you’re asked to provide more information, but fail to respond within 30 days, your enrollment will be automatically denied.

What if I enroll in one plan but then find another I prefer?

In most circumstances, you can switch drug plans only during the open enrollment period (Oct. 15 to Dec. 7). Enrolling in another plan automatically cancels your enrollment in a previous one. However, if you receive Extra Help or live in a nursing home, you can change plans at any time of the year. Also, if you want to switch to a plan that has earned Medicare's top five-star quality rating, you can make this change at any time of the year.

When is the latest I can sign up?

Technically, you can sign up with a Part D plan on the very last day of your enrollment period. However, it takes time for a plan to process your enrollment information and upload it into the computer system. To be sure of getting your prescriptions filled at the pharmacy without delay on day one of coverage, it’s best to sign up about two weeks earlier if possible, instead of waiting until the last minute.

What if I change my mind?

In most cases, you will be locked into the plan you enrolled in until the next open enrollment period comes round in a year’s time.  However, if you joined a Medicare Advantage plan and decide, for any reason, that you want to return to traditional Medicare, you can do so during the annual “disenrollment” period that runs from Jan. 1 to Feb. 14 each year.  During this period you can also sign up with a “stand-alone” Part D plan for drug coverage.  You can use this time frame to disenroll from a Medicare Advantage plan regardless of how long or short a time you’ve been in it.

When will my drug coverage start?

Usually it begins on the first day of the month after you enroll. If you switch plans during annual enrollment (Oct. 15 to Dec. 7), coverage in your new plan starts on Jan. 1.

How can I avoid scams?

Scammers may pretend to be from a Medicare drug plan to get your financial information. Here’s what you need to know to protect yourself:

  • Companies approved by Medicare can market their plans by mail but not door-to-door or over the phone unless you’ve invited them to (whether or not your number is registered on an official Do Not Call list).
  • Approved companies cannot ask you to enroll on the phone if they have initiated the call — you must call them. Call Medicare at 1-800-633-4227 to verify the name and phone number of a plan if you’re not sure.
  • Do not give out your Medicare ID, Social Security, bank account or credit card numbers, or other financial details to anyone who calls. A legitimate caller won’t ask.
  • Don’t believe anyone who tries to persuade you to enroll in a plan by saying that signing up is required by law, that you’ll lose other Medicare benefits if you don’t or that there is a fee for enrolling.

Report possible fraud to Medicare or to your state attorney general’s office or consumer protection agency. If you’re ripped off and worried you may be the victim of identity theft, take immediate action. For guidance on what to do next, go to the website of the Federal Trade Commission, or the Privacy Rights Clearinghouse.

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