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medicare infoFAQ: About Medicare Prescription Drug Coverage (Part D)

What is Medicare Prescription Drug Coverage?
Do I have to enroll in Medicare Part D?
How much does Part D cost?
Who can help me choose a Part D Plan?
When can I enroll in Part D?
What is extra help?
Who qualifies for Extra Help?
How can I apply for Extra Help?

What is Medicare Prescription Drug Coverage?
Medicare offers prescription drug coverage to everyone who has Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

There are two ways to get Medicare prescription drug coverage:

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Do I have to enroll in Medicare Part D?
No, Part D is voluntary. However, if you decide not to join a Part D plan when you are first eligible, and you do not have other coverage that is as good as or better than a Medicare prescription drug plan, you will probably pay higher monthly premiums if you join later.

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How much does Part D cost in 2016?
Here is how the cost-sharing works in a standard Part D plan. Costs listed in the steps below change every year, and the details of individual plans may vary.

Premiums. This is the monthly fee you pay to participate in the plan. Premiums average about $30, and you must pay the premium each month.

Step 1, Annual Deductible. This is the amount you pay before your insurance coverage begins. The standard deductible is $360.

Step 2, Co-Insurance. This is the amount you pay at the pharmacy for your covered prescriptions after the deductible. You pay your share, and your drug plan pays its share for covered drugs.

Step 3, Coverage Gap (Donut Hole). Once your costs have reached $3,310, your plan pays a reduced share, and you must pay a larger share of your medication cost until the total amount you have paid reaches $4,850.

Step 4, Catastrophic Coverage. Once your medication cost has reached $4,850, your plan will pay most of the cost of your medications for the remainder of the calendar year. You will then pay approximately 5% of the cost, or a small flat amount.

Each January 1, you begin again at Step 1, the annual deductible.

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Who can help me choose a Part D Plan?
Benjamin Rose Institute on Aging has trained staff who can help you choose and enroll in a plan. Our Call Center is open Monday through Friday, from 9:00 AM to 5:00 PM, and provides this service free of charge. Call 216.373.1650 or toll-free 1.866.885.1650.

Medicare can also help you choose and enroll in a plan. Call 1-800-MEDICARE (1.800.433.6227).

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When can I enroll in Part D?
You can enroll when you first become eligible for Medicare, or between October 15 and December 7, or anytime if you qualify for Extra Help.

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What is Extra Help?
Extra Help, also called the Low Income Subsidy (LIS), is financial assistance for Medicare beneficiaries who have limited income and assets. Those who are eligible may have all or part of their premiums and deductibles waived, will pay reduced co-insurance, and will not be subject to the coverage gap (donut hole).

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Who Qualifies for Extra Help?

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How Can I Apply for Extra Help?
Benjamin Rose Institute on Aging has trained staff who can submit your application for Extra Help, which will be forwarded to the Social Security Administration. Determination is made in approximately three weeks, and a letter will be sent to you regarding your eligibility. Our Call Center is open Monday through Friday, from 9:00 AM to 5:00 PM, and provides this service free of charge. Call 216.373.1650 or toll-free 1.866.885.1650.

Social Security Administration can also take your application over the telephone or will mail you a paper application, if you prefer. Call 1.800.772.1213.

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