En español l Once you’ve chosen a Part D plan, it’s easy to sign up. But first make sure that it’s the plan you want and that you haven’t been talked into it by a salesperson who doesn’t have your best interests at heart.
How can I enroll?
1. On the phone by calling Medicare at 800-633-4227. If you’re hard of hearing and use TTY, call 877-486-2048 toll free.
2. Online at www.medicare.gov. If you use the plan finder program to compare Part D or Medicare Advantage plans, you can enroll in the one of your choice by clicking on the “Enroll” button shown alongside the plan’s name. You will be required to fill out an application form.
3. By contacting the plan of your choice at its website or at the phone number provided in its brochure or on Medicare’s website.
When can I enroll?
If you’re signing up with a Part D plan for the first time, you may do so in one of three different enrollment periods, depending on your circumstances:
Initial Enrollment Period (IEP): If you’re not yet in Medicare and have no other drug coverage that’s “creditable” (considered as good as Medicare’s), you can join a drug plan at any time during your seven-month initial Medicare enrollment period. This lasts from three months before to three months after the month you turn 65 (or, if you’re younger with disabilities, the month you receive your 25th Social Security disability payment). You can also use this IEP if you turned 65 while living abroad or in prison. It lasts from three months before to three months after the month of your return or release.
Special Enrollment Period (SEP): You’re entitled to an SEP in certain circumstances — for example, if you lose creditable drug coverage (such as from an employer or union), or you turned 65 before moving abroad or going to prison and now want Part D coverage on your return or release. You also get a SEP to switch to another plan if you’re already enrolled in Part D, in certain situations—for example, if you move your main residence to somewhere outside your plan’s service area; or you move into or out of a nursing home. You do not have to request an SEP in these circumstances, but can just go ahead and sign up with a plan. This kind of SEP lasts 63 days and you must be receiving Part D coverage before it expires to avoid a late penalty. You can also get a different type of SEP if you missed your deadline for enrolling in Part B and had to sign up during a general enrollment period, which runs from January 1 to March 31 each year, with coverage not starting until July 1 of the same year; in these circumstances you can sign up for a Part D plan from April 1 to June 30, with coverage beginning July 1, instead of waiting for open enrollment.
Annual Open Enrollment Period (OEP): If you miss your deadline for joining Part D during an IEP or an SEP, then you cannot enroll in a drug plan until the next OEP. This enrollment period runs from Oct. 15 to Dec. 7 each year, with coverage beginning Jan. 1. You also have to wait for an OEP if you deliberately drop creditable drug coverage that you already have (for example, from an employer or union). The OEP also serves as an annual opportunity for anybody already enrolled in Part D to switch from one plan to another.
What questions will I be asked?
Whether you enroll online, on the phone or on a written form, you must answer certain standard questions for your enrollment to be considered complete. These include:
- Your primary address: This is the place you consider your normal home—the one used on your tax form and driver’s license—even if you live part of the year in another state. You cannot be enrolled in two Part D plans in different places, and your primary home must be within the service area of the plan you choose. If you don’t have a fixed address, the Part D plan you want may accept the address of a shelter or clinic, a PO box number or wherever you receive mail.
- Whether you have (or had) other drug coverage: Medicare requires this information to ensure that your other benefits can be coordinated with Part D, so that the pharmacist knows what to charge you and who to bill for the balance. Also it allows the plan to confirm that you know the consequences of joining Part D, in case doing so would affect your other coverage adversely. And it shows whether you’ve been without creditable drug coverage for long enough to incur a Part D late penalty.
- How you want to pay your premiums: You must choose one of three options: having the plan bill you directly; having the premiums deducted automatically from your Social Security check; or arranging for the premiums to be sent to the plan automatically by electronic funds transfer from your bank account. You are asked to indicate your preference on the enrollment form and generally must stick with your choice for the rest of the year.
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, and there is one available in your area, you can make this change once at any time of the year except for the first week in December..
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, unless you qualify for any of the special enrollment periods described above. 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.
How can I avoid hard sells?
It may not happen to you, but some beneficiaries have been pressured into buying Medicare insurance plans that they didn’t understand or want. Typically, beneficiaries are sold Medicare Advantage plans (which combine health services with drug coverage) without realizing that this means leaving traditional Medicare and maybe not being able to receive covered care from their regular doctors and hospitals. Although the federal government cracked down hard on these unethical practices and made some of them illegal in 2008, it’s by no means certain that they have stopped entirely. Here’s what you need to know to protect yourself against falling for a hard sell:
- It’s illegal for a plan to send anyone to your home uninvited to sell Medicare insurance of any kind. Don’t believe anyone who says they’re “from Medicare.”
- It’s illegal for anyone representing a plan to call you on the phone with a sales pitch, unless you requested the call or already have a relationship with the plan.
- It’s illegal for a plan to enroll you in a plan on the phone — unless you call the plan to do so.
- It’s illegal to ask you for any personal or financial information on the phone.
- It’s illegal for a plan to offer free meals, cash or other gifts to encourage you to enroll, or to give sales presentations anywhere that patients go for health care related services (such as doctors’ offices, hospitals and long-term care facilities) or at educational events.
- If you ask a sales agent to come to your home to discuss a particular kind of insurance (whether a stand-alone drug plan, a Medicare Advantage health plan or medigap supplementary insurance), be aware that the agent must discuss only that type of insurance. If you want to discuss a different type, you must schedule a separate appointment, at least 48 hours after the first.
- If a sales agent signs you up for a Medicare Advantage plan, the plan should call you to check that you understand its conditions and consequences and offer you the chance of withdrawing from the enrollment if you want to.
- Don’t be rushed into enrolling. Take a few days to consider.
- Don’t sign anything until you’re sure the plan is what you want. If you’re not sure, call the Medicare help line at 800-633-4227 and quote the plan’s name and ID number to learn what kind of plan it is and how enrolling in it might affect your current coverage.
- Don’t sign anything until you know that the doctors, specialists and hospitals you prefer will accept the plan — even if a salesperson tells you it’s “good anywhere.”
If you use an independent insurance agent, try to choose one who is not paid to sell just one plan but can help you review many options to find your best deal.
Better still, go to the Medicare website for impartial information on all the options — original Medicare, Medicare Advantage plans, prescription drug plans and medigap supplementary policies — and to compare their costs and benefits. Or call the Medicare help line at 800-633-4227.
What can I do if I find I’ve been tricked into joining a plan?
If you find you’ve enrolled in a Medicare Advantage plan because you were confused or misled, call the Medicare help line and ask to be reenrolled in original Medicare or switched to another MA plan. Medicare will investigate your case.
If you already have medical bills the plan refuses to pay, ask to be reenrolled in the traditional (aka original) Medicare program retroactively, so Medicare can pay the bills at its usual rate. If that doesn’t work, ask to talk to a caseworker at your regional Medicare office.
If you’re receiving Extra Help, you can switch to another MA plan or back to original Medicare at any time.
How Do Medicare Plans Differ?
It’s easy to confuse the different types of Medicare insurance. But understanding the differences between them is good protection against hard sells and unscrupulous sales people. Here is what each type means:
- Traditional Medicare (also known as original Medicare) provides basic coverage for hospitals (Part A) and doctors and outpatient services (Part B). It doesn’t cover vision, dental or hearing care or outpatient prescription drugs. You can go to any doctor or hospital nationwide that accepts Medicare.
- Medigap supplementary insurance is not a government-run program but private insurance you can choose to buy yourself. It covers some or most out-of-pocket expenses incurred in traditional Medicare, and may provide some extra coverage, depending on the individual policy you buy. You can choose one of 10 policies, each with its own set of benefits that are standardized in law but are sold by many insurance companies, which may charge different premiums.
- Medicare stand-alone prescription drug plans (PDPs) cover only outpatient drugs and are mainly intended for people in traditional Medicare who have no other drug coverage. You can’t enroll in both a PDP and a Medicare Advantage plan at the same time even if the plan doesn’t include drug coverage, unless it’s a Private Fee for Service plan or a Medicare Savings Account. If you enroll in any other kind of MA plan, whether or not it covers drugs, you will automatically lose your current PDP coverage.
- Medicare Advantage plans (MAs) cover everything traditional Medicare covers, but may offer lower costs and extra services. Each plan has a different mix of costs and benefits and may or may not include prescription drug coverage.
Traditional Medicare will no longer provide your benefits if you enroll in any of the following MA plans:
- HMOs are managed-care plans that usually require you to go to doctors and hospitals in the plan’s network, except in a medical emergency, and require you to be referred to a specialist by a primary care doctor..
- PPOs are managed-care plans that allow you to see specialists without a referral. You pay more if you go to a doctor or hospital outside the plan’s network, except in a medical emergency.
- PFFS plans are private fee-for-service plans that allow you to go to any doctor or hospital that accepts their terms. Not all providers agree to the terms, and providers are allowed to reject or accept a plan on a visit-to-visit basis. In an emergency the plans must cover treatment by any doctor or hospital. PFFS plans are not available in all areas.
- MSAs are Medicare medical savings accounts that put a certain amount of money into a bank account for you to spend on health care. Once this money runs out, you enter a deductible phase when you spend 100 percent of your health care costs out of pocket. After the deductible is met, the plan pays 100 per cent of your costs until the end of the year. MSAs are available in only a few areas.
- SNPs are special needs plans that are only for people who live in long-term care facilities, receive both Medicaid and Medicare, or have certain illnesses. SNPs are usually HMOs.
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