Medicare Part D FAQ
Here are some of the most frequently asked questions about Medicare Part D and drug formularies. If your question is not included, please send us an email and we will get back to you as quickly as possible.
- Who can get Medicare Part D prescription drug coverage?
- Do I have to enroll in Medicare Part D?
- Can I get Medicare Part D prescription drug coverage if I don’t have a Medicare supplement or Medicare Advantage plan?
- If I am turning 65 and want Medicare Part D drug benefits, can I join a Medicare Prescription Drug Plan or Medicare Advantage plan only at certain times of the year?
- I’m currently enrolled in a Medicare supplement plan with prescription drug coverage. Do I have to change plans if I want to keep my prescription drug coverage?
- If I am currently enrolled in a Medicare supplement plan that includes prescription drug coverage and want to enroll in a Medicare Part D plan, can I?
- What is the Medicare Part D formulary?
- How will my doctor know to prescribe a medication on the formulary?
- What is the mail order program for Medicare Part D?
1. Who can get Medicare Part D prescription drug coverage?
All Medicare beneficiaries are eligible to enroll. You must be entitled to Medicare Part A or enrolled in Medicare Part B. You must also live in the service area of the plan you join. Our service area includes Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. For Keystone 65 HMO, you must be a resident of Bucks, Chester, Delaware, Montgomery or Philadelphia counties in Pennsylvania. For Personal Choice 65 PPO, you must be a resident of Bucks or Philadelphia counties in Pennsylvania.
2. Do I have to enroll in Medicare Part D?
No. Enrollment in Medicare Part D is voluntary. However if you don’t enroll in a Part D plan as soon as you’re eligible, you may pay a penalty if you enroll later.
3. Can I get Medicare Part D prescription drug coverage if I don’t have a Medicare supplement or Medicare Advantage plan?
Yes. If you are enrolled in Original Medicare, you can continue with it and choose your Part D coverage from a private plan that provides coverage only for prescription drugs.
4. If I am turning 65 and want Medicare Part D drug benefits, can I join a Medicare Prescription Drug Plan or Medicare Advantage plan at any time?
No. If you are turning 65, you may enroll in a Medicare Prescription Drug Plan or Medicare Advantage plan during your Initial Coverage Election Period for Medicare Part B. This period includes the three months prior to your birth month, your birth month, and the three months after your birth month.
5. I’m currently enrolled in a Medicare supplement plan with prescription drug coverage. Do I have to change plans if I want to keep my prescription drug coverage?
No. As long as you are enrolled in a Medicare supplement plan that provides prescription drugs prior to January 1, 2006, you can remain in this Medicare supplement plan. However, if you decide to enroll in a Medicare Part D drug plan later, you may pay a penalty for late enrollment.
6. If I am currently enrolled in a Medicare supplement plan that includes prescription drug coverage and want to enroll in a Medicare Part D plan, can I?
Yes. You can move to a medical-only Medicare supplement plan and join a standalone Part D drug plan.
7. What is the Medicare Part D formulary?
A formulary is a defined list of medications that have been selected for their medical effectiveness, positive results, and value. When you have your prescription filled at a participating network pharmacy, you will have lower out-of-pocket costs when you use a drug on the formulary. If a drug is not on the formulary, your out-of-pocket costs will be higher. A mail order pharmacy is also available.
8. How will my doctor know to prescribe a medication on the formulary?
Have your doctor review the Drug Formulary Pocket Guide to determine if your prescription medications are on the formulary. You might already be taking formulary medications. If you are, you will pay only your cost-share for these drugs. If you are prescribed covered drugs that are not on the formulary, ask your doctor to review your Drug Formulary Pocket Guide to see if another drug on the formulary, such as a generic equivalent or therapeutic alternative, can be used to treat your condition. If, after discussion with your doctor, he/she does not prescribe a formulary medication, your covered prescription will be subject to the higher cost-share.
9. What is the mail order program for Medicare Part D
The voluntary mail order program saves you copays and allows you to get medications delivered directly to your home. When you are prescribed a maintenance drug, ask your doctor to write you two prescriptions — one for a 31-day supply to be filled immediately at a local, participating pharmacy and one for a 90-day supply (plus any necessary refills) to be filled through mail order. Once you are enrolled, you will receive a mail order envelope in your Welcome Kit. You may obtain additional mail order envelopes by calling the number on the back of your identification card or contact us.
You must continue to pay your Medicare Part B premium.
The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1, 2013. Members may enroll in the plan during specific times of the year. Contact the plan for more information. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits, as well as limitations, copayments, and restrictions. Members must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.”
You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Keystone 65 HMO or Personal Choice 65 PPO will be responsible for the costs.
Please contact Keystone 65 HMO or Personal Choice 65 PPO Customer Service for more information.
Y0041_HM_12_300a Pending CMS Approval
