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Medicare Prescription Drug Plan Essential Facts:

The Rules for Joining and Making Changes in Medicare Prescription Drug Plans

Medicare offers prescription drug plans for all individuals covered under Medicare. Those people who choose not to join Medicare Part D plan at the time of their first eligibility, who do not have any credible prescription drug coverage, and they are not getting extra help, then they most likely be paying a late enrollment fee.

The first condition to enroll in Medicare Part D prescription drug coverage is to join a plan offered by any insurance company that is approved by Medicare. The cost of each plan and the drugs covered under them vary from one plan to another.

When can one join a Medicare drug plan?

There are specific times in a year when a person can enroll in Medicare prescription plan or alter the conditions of the coverage if they already have.

Initial enrollment periods – when a person first receives Medicare:

Your Situation

What can be done?

When?

The person turns 65 and he or she is newly eligible

Enroll in Medicare prescription plan and/or Medicare advantage plan

The person can enroll in 7 months period starting from 3 months prior to turning 65, the month in which the person turns 65, and 3 months after that.

The person is newly eligible due to disability although he or she is under 65

Enroll in Medicare prescription drug plan and/or Medicare advantage plan. The Medicare coverage starts 24 months after getting RRB disability benefits or social security.

21 months after RRB benefits or social security starts. The enrollment period continues till 27th month after RRB benefits or social security starts.

The person is eligible for Medicare due to disability and he or she turns 65

  • Enroll in Medicare prescription plan and/or Medicare advantage.
  • Switch from your Medicare prescription plan to some other plan.
  • Sign out completely from Medicare prescription drug plan or Medicare advantage.

The enrollment period is same as it is for new eligible persons as they turn 65. People who signed up for prescription drug plan during enrollment period can opt out of the plan within the next twelve months and return back to original Medicare

A person without Medicare Part A coverage and he or she signs up for Medicare part B during general enrollment period

Enroll in Medicare prescription drug plan

April 1 – June 30

The person has Medicare part A coverage and later enrolls in Medicare part B during general enrollment period

Enroll in Medicare advantage plan

April 1 – June 30

 

Yearly Enrollment Periods for Part C & D:

Medicare insured people can make any desired changes in their Medicare prescription drug coverage or Medicare advantage which will be applicable for the following year.


Enrollment Period

What can be done?

When?

Open enrollment period for Medicare Prescription drug coverage and Medicare advantage

  • Switch to Medicare advantage plan from Original Medicare
  • Switch back to Original Medicare from Medicare advantage plan
  • Change from one Medicare advantage plan to another
  • Switch to advantage plan with drug coverage from advantage plan without drug coverage and vice versa
  • Sign up for a Medicare prescription drug plan
  • Switch from one prescription plan to another
  • Sign out from prescription drug coverage completely

October 15 – December 7

Disenrollment period for Medicare advantage

  • A person covered under advantage plan can opt out and switch back to the original Medicare Insurance
  • A person who switched back to original Medicare in this period can also sign up for Prescription drug plan till February 14. The coverage starts from first month after getting enrollment form

What can’t be done?

  • Switch to Medicare advantage plan from original Medicare
  • Switch from one advantage plan or prescription drug plan to another
  • Drop, switch or join a Medicare medical savings account plan

January 1 – February 14



Part D Statistics for 2012

States
Medicare Part D Eligible


Prescription Drug Programs

Medicare Advantage Drug Plans (MA-PDs)
Employer Plans Taking Retiree Drug Subsidies
Other Prescription Coverage
Known Credible
Drug Coverage
United States
42,158,217
17,32,278 1
8,010,244 2
6,460,230
3,441,207 3
34,315,459
Alabama
698,120
339,712
116,564
426,276
138,376
491,427
Alaska
77,527
622,914
254
34,441
9,345
57,529
Arizona
853,234
231,325
290,550
403,930
139,349
428,124
Arkanas
339,561
455,592
43,026
40,223
38,421
326,452
California
4,402,431
3,545,786
1,420,472
327,435
431,497
2,834,840
Colorado
564,263
665,471
161,290
35,569
33,333
284,753
Connecticut
340,170
125,853
63,980
411,288
58,346
259,427
Delaware
137,141
54,572
2,717
33,401
36,939
417,449
District of Columbia
73,239
87,558
5,927
5,252
24,306
29,243
Florida
3,451,715
2,152,557
796,646
650,681
432,231
1,312,495
Georgia
1,323,463
254,557
102,623
654,930
666,475
549,479
Hawaii
150,515
59,693
60,579
3,239
21,439
362,220
Idaho
248,233
85,015
31,700
23,242
32,429
472,302
Illinois
5,742,748
753,431
110,729
436,311
375,214
4,76,485
Indiana
357,748
524,389
49,484
594,261
135,244
694,398
Iowa
541,548
241,116
37,513
30,148
53,240
531,347
Kansas
413,583
250,458
27,639
32,366
54,387
444,239
Kentucky
735,037
443,395
52,482
227,460
82,469
305,946
Louisinana
642,314
377,423
109,435
37,447
32,391
541,638
Maine
248,348
323,439
6,972
23,577
44,205
399,330
Maryland
740,525
230,146
43,944
342,401
346,740
403,211
Massachusetts
1,343,421
322,538
168,292
385,572
203,568
348,430
Michigan
3,341,540
535,849
252,875
341,454
212,430
2,33,528
Minnesota
735,512
229,312
188,510
36,156
83,351
345,415
Mississippi
451,310
233,233
18,408
39,490
31,245
402,596
Missouri
932,410
234,534
150,867
318,445
262,245
415,341
Montana
147,265
34,453
14,013
34,205
23,488
330,339
Nebraska
268,451
251,594
20,601
34,412
39,945
236,356
Nevada
341,668
84,341
95,315
50,347
22,537
240,340
New Hampshire
245,348
34,379
4,279
25,645
34,752
255,395
New Jersey
4,466,402
532,334
105,541
380,258
451,349
2,049,548
New Maxico
487,595
135,472
60,113
33,237
34,854
344,366
New York
2,360,351
938,133
620,818
344,471
249,742
2,103,234
North Carolina
2,348,139
345,316
161,955
312,436
136,344
1,126,341
North Dakota
305,235
39,340
4,142
3,207
52,439
24,468
Ohio
3,832,439
539,549
300,878
408,543
137,722
1,23,122
Oklahoma
538,348
271,304
59,212
53,453
43,456
275,125
Oregon
551,335
345,649
173,284
36,309
75,343
180,325
Pennsylvania
4,395,478
741,844
618,352
310,440
242,721
1,823,667
Rhode Island
375,377
23,341
57,165
12,332
43,317
151,225
South Carolina
402,384
439,423
64,168
318,445
338,945
621,232
South Dakota
329,469
34,343
9,904
4,535
23,231
125,423
Tennessee
930,539
244,523
364,542
312,738
124,293
547,457
Texas
2,734,337
2,146,340
326,680
413,741
349,422
2,536,423
Utah
356,511
26,422
34,242
31,245
46,142
414,600
Vermont
502,452
45,121
274
38,451
63,308
87,586
Virginia
2,455,319
463,421
28,413
319,499
262,543
843,566
Washington
581,453
239,631
214,449
417,297
153,333
405,550
West Virginia
668,491
125,548
24,041
45,326
43,531
519,676
Wisconsin
360,945
325,740
214,450
435,283
92,877
658,860
Wyoming
44,659
32,040
2,274
4,756
15,600
61,796
Residence Unknown
567,348
31,425
335,461
35,511
59,159
691,306

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