What is Medicare Part D?

Part D is the prescription drug coverage portion of Medicare. Part D prescription drug coverage is available through private insurance companies that offer Medicare-approved private plans, or Medicare Drug Plans.

Medicare Drug Plans fall into two main categories:

• Prescription Drug Plans (PDPs), or prescription-only coverage
• Medicare Advantage Prescription Drug Plans (MA-PDs), which combine the benefits of Medicare Part A (hospitalization), Part B (outpatient medical care), and Part D (prescriptions) into one plan. You can generally get some additional medical coverage through MA-PDs, but you will likely be limited to a network of providers.

There are also Medicare Advantage Plans and Medicare Supplement Plans available that offer medical coverage to go with your Medicare Part B. They do not offer prescription coverage, so they are not covered further here. You can find more information about these plans on the Medicare website.

There are many different Medicare Drug Plans to choose from and each plan may have a premium. Evergreen can assist you in choosing the Part D plan that is best for you and in paying your premium.

Medicare Part D has tiers of prescription coverage that are different from most other types of insurance coverage. There are times of the year when you may be responsible for significant prescription costs, even though you have prescription coverage. When you are an EIP client, EIP can help you with some of these costs. The Low-Income Subsidy, or Extra Help can also help you with these costs.

Am I eligible for Medicare Part D?

Anyone who has Medicare, or becomes eligible for it, is entitled to prescription drug coverage through Part D.

• If you have Medicare Part A or Part B, you are eligible for PDPs. PDPs are statewide plans.
• If you have Medicare Parts A and B, you are eligible for both PDPs and MA-PDs. Please note that MA-PDs vary considerably in the different counties of Washington State.

If you have Medicare and Medicaid, you also have medical coverage through Medicaid. Therefore, you probably do not need the extra medical coverage of an MA-PD.

People with Medicare and Medicaid and other low-income populations can qualify for Extra Help. If your income is below 150% Federal Poverty Level, EIP does require that you apply to Extra Help. This can help reduce your prescription costs.

Can Evergreen pay for my Medicare Part D premiums?

Yes, Evergreen can pay for PDPs, as well as MA-PDs that have prescription drug coverage.

• If you have Medicare and Medicaid, you may not be responsible for a Part D premium. You can choose to enroll in a Part D plan with richer benefits that does have a premium for you to pay. Evergreen can help you with this premium.

If you are a current EIP client, and EIP is helping you meet your Medicaid spenddown, Evergreen can only pay for your MA-PD if:

• DSHS will not pay for your MA-PD policy.
• You need the MA-PD in order to continue to receive services that are very important for the treatment and management of your HIV infection.

How do I apply for Medicare Part D?

You can go online to www.medicare.gov to see the list of plans available in your area. You should choose a plan that offers the best coverage based on prescriptions you currently take and anticipate taking in the future. An insurance advocate at Evergreen or your case manager can help you review your options and choose the best plan for you.

Here are some resources to help you choose the best Medicare Drug Plan for your needs:

• A worksheet to help you gather the information you will need to enroll in a Part D plan.
• A training to help you understand how to use the online Drug Plan Finder. The training is available in PowerPoint and webinar formats.

After selecting the best Medicare Drug Plan for you:

• Fill out the Part D application online. Print out and save a copy of the resulting confirmation notice that appears on your computer. You can also submit a paper application, but the online application is much faster. If you submit a paper application, be sure to retain a copy.
• Submit your copy of your Part D enrollment confirmation and a copy of your Medicare card along with an application to Evergreen. Also enroll in EIP if you are not a current EIP client.
• We will process your application and send a check to your Part D Plan once we receive a bill from the part D plan. This bill may go directly to you; please be sure to mail it to Evergreen if it does.

Other important information about Medicare Part D

There are specific limited enrollment periods:

• When you first become eligible for Medicare due to turning 65, you can enroll in a PDP or MA-PD three months before the month of your 65th birthday, or up to three months after, for a total of seven months.
• If you become eligible for Medicare due to a disability, you can enroll three months before to three months after your 25th month of receiving cash disability payments.

Please note that not enrolling in a PDP or MA-PD may result in penalties. However, if you currently have insurance coverage that is as good as the coverage offered by a Medicare Drug Plan, you may be able to keep that policy without enrolling in a Medicare Drug Plan. Please contact your case manager or the Evergreen Health Insurance Program for more information.

If you did not enroll in a PDP or MA-PD when you became eligible, note that open enrollment will be held between November 15 and December 31 of each year.

• If you are eligible for a MA-PD, you can enroll or switch MA-PDs between January 1 and March 31 of any year.
• People with both Medicare and Medicaid, or people with Extra Help, can change their Part D plan once a month.

The benefits and formularies of Part D plans can change from year to year. Please review the information from your Part D plan every fall. Make sure your plan will still work for you in the coming year.

For more detailed information please visit the Medicare website.