Medicare Part D

We've put this section together to help answer some of your questions, but feel free to contact us with your questions.

Medicare Part D is the federal government's prescription drug program that covers both brand-name and generic prescription drugs at participating pharmacies in your area. The coverage is available to all people eligible for Medicare, regardless of of income and resources, health status, or current prescription expenses. Medicare prescription drug coverage provides protection for people who have very high drug costs.

How does Medicare prescription drug coverage work?
Medicare Part D works in tandem with Medicare Parts A and B. Individuals entitled to Part A or enrolled in Part B can sign up for Part D to receive help paying for prescription drugs. Like other insurance, if you join, you will pay a monthly premium, which varies by plan, and (for most plans) a yearly deductible (no more than $275 in 2008, $295 in 2009). You will also pay a part of the cost of your prescriptions, including a co-payment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. Plans also vary in terms of the co-pays, prescription drugs that are covered (this is called the "plan formulary") and the pharmacies that may be used.

If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. Individuals enrolled in both Medicare and Medicaid ("Dual Eligibles") who have not already selected a Part D plan will be automatically enrolled in Medicare Part D by their state agency.

If I am on Medicare do I have to enroll in Part D?
Medicare Part D is an optional plan. No one is required to enroll but if you are eligible and delay enrolling during the open enrollment period you risk paying a penalty in terms of increased insurance premiums when and if you enroll at a later date.

How do I get more information and enroll?
Enrolling in Medicare Part D is easy. Call us at 941-492-4110 for a free Medicare Part D quote. We can answer your questions and handle your enrollment over the phone and mail or personally deliver an application to you if you wish. Coverage becomes effective on the first day of the month after your enrollment.

What is Open Enrollment?
The Open Enrollment period for Medicare Part D (officially, the Medicare Part D Initial Enrollment Period - IEP) is a one-time event when an individual first has the opportunity to enroll in a Medicare Part D Prescription Drug Plan (PDP). It occurs for most people when turning age 65 and enrolling in Medicare Parts A & B for the first time. For people turning 65 the Part D IEP lasts seven (7) months (same as the : it begins three (3) months prior to your birth month, includes your birth month, and extends three (3) months after your birth month. In addition, people of any age enrolling in Medicare Part B for the first time may apply for Medicare Part D three months prior to their requested effective date for Part B, during the month of their Part B effective date as well as three months after their Part B effective date.

What is the Annual Election Period (AEP)?
The Annual Election Period for coverage effective in 2009 begins November 15, 2008 and ends December 31st, 2008. Anyone who already enrolled in a Medicare Part D plan may change plans during this period each year without penalty. Eligible individuals (people on Medicare) who chose not to enroll during their initial Open-Enrollment Period may enroll in Medicare Part D between November 15 and December 31 each year, but penalties will apply unless the individual had "creditable" prescription drug coverage. Enrollments during this period have an effective date of January 01, 2009.

What is a Special Election Period (SEP)?
A Special Election Period means that you are allowed to enroll in Medicare Part D without penalty after the Initial Election Period and/or Annual Election Period because you meet certain conditions set forth by the government. Below are the specific situations which might qualify you for a SEP.

You may qualify for a Special Election Period if:

• You are a Hurricane Ike evacuee and reside in certain zip codes as identified by the Federal Emergency Management Agency at the time of the hurricane (August 2008).
• You move permanently outside your plan's service area.
• You're enrolled in another prescription drug plan or a Medicare Advantage plan whose contract is terminated.
• You are not adequately informed about creditable prescription drug coverage.
• You lose your previous creditable coverage through no action of your own*.
• Your enrollment or non-enrollment is caused by an error by a federal employee or contractor hired by the federal government.
• You were eligible for both Medicare and Medicaid (a “dual eligible”) but you lost your dual eligibility status.
• You want to move from an employer-sponsored prescription drug plan to a Medicare Prescription Drug Plan.
• You want to leave your current Medicare Prescription Drug Plan because it was reprimanded by the federal government or the federal government has determined the plan violated a material provision of its Medicare contract in relation to services provided to you.
• You’re enrolled in a Cost Plan that isn’t renewing its contract with Medicare. This SEP begins 90 calendar days prior to the end of the contract year (i.e., October 1) and ends on December 31 of the same year.
• You want to move from a Program of All-Inclusive Care for the Elderly—PACE—to a Medicare Prescription Drug Plan.
• You live in—or are moving in or out of—a skilled nursing facility, nursing facility, intermediate care facility for the mentally retarded, psychiatric hospital or unit, rehabilitation hospital or unit, long-term care hospital or swing-bed hospital.
• Your Medicare entitlement determination is made retroactively
• You are not eligible for premium free Part A and enroll in Medicare Part B during the January-March Part B General Enrollment Period.
• You have a low-income subsidy.
• The federal government may authorize other special election periods.

*To avoid a penalty, individuals must apply for Medicare Part D within 63 days of losing "creditable" presciption drug coverage, which is coverage that is at least as good or better than the standard benchmark level of Medicare Part D Prescription Drug coverage as determined by the individual's coverage provider.

Can I change my Part D plan after I enroll?
Once enrolled in a Medicare Part D Prescription Drug Plan indiviuals can only change their plan from November 15 to December 31 of each year, with an effective date of January 1 of the following year.