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Medicare and Your Prescription Coverage

Many people get confused about some of the “alphabet soup” terminology used to describe different Medicare coverages, leading them to miss out on important deadlines and enrollment periods. Medicare Part D - for drug coverage - is one option you need to understand, both because of the substantial benefits it provides and the potential for penalties if you do not select it at the right time. If you do not opt in or qualify for certain exceptions, you could be paying more for prescription coverage, and you will be doing so for as long as you have Medicare.

Given these harsh consequences, you should discuss your situation with a Michigan Elder Law attorney to make sure you enroll in Medicare Part D under proper circumstances and in a timely fashion. Here are some answers to frequently asked questions that provide basic information.

Am I Eligible for Part D?

Not everyone qualifies for Medicare drug coverage under Part D, so you must meet certain eligibility criteria. You must be 65 years or older, and be entitled to Medicare Part A and/or currently enrolled in Part B. Additionally:

  • You must suffer from a disabling medical condition for which you receive Social Security Disability Insurance (SSDI) for more than 24 months; OR,
  • You have been diagnosed with permanent kidney failure that requires a kidney transplant or dialysis.

Why Should I Consider Part D Coverage?

Even if you are eligible, drug coverage under Part D may not be the most beneficial option. Selecting coverage may be wise if you:

  • Regularly take prescription medications;
  • Think you may need prescription drugs at some point in the future;
  • Do not have “creditable” coverage, which pays as much as Medicare on average; and,
  • You are worried about drug costs or have trouble paying for your prescriptions.

How can I Enroll in Medicare Part D?

You can opt for Part D by filling out the proper forms within the relevant time periods, which will vary based upon your situation. If you are enrolling for the first time, you should do so during your Initial Enrollment Period, the seven-month period that begins three months after you turn 65. You may also qualify to enroll during the open enrollment period running from October 15 to December 7.

What are the Penalties for Not Enrolling on a Timely Basis?

If you miss your enrollment period, you will receive a 1% penalty for each month that you delay. The Part D late enrollment penalty applies immediately, and continues as long as you have Medicare. There is an exception when you can show that you had creditable drug coverage during the interim.

Talk to an Elder Law Attorney About Part D

These answers to common questions about Part D coverage and enrollment may be useful, but it is critical to get personalized information regarding your specific circumstances. To learn more, please contact the Nawrocki Center for Elder Law to speak with a member of our team. You can call 810-893-5277 or go online to set up a consultation at our offices in West Branch or Brighton, MI.

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