If you have Medicare, you are eligible for Medicare prescription drug coverage, also known as Medicare Part D. It’s an optional addition to your healthcare coverage that would have required you to pay an additional monthly premium.
But if you received a yellow Medicare Part D Auto-Enrollment Notice, your Part D membership may be free!
Then you may automatically qualify for the Medicare Part D Extra Help program.
If this is the case, you’ll receive a Part D auto-enrollment notice (also known as CMS Product No. 11154). This yellow letter is sent to inform you that you meet the auto-enrollment requirements and will be enrolled in a pre-selected Medicare Prescription Drug Plan unless you decide to join a plan on your own.
The automatic enrollment notice lets you know:
- Information about the plan you’ll be automatically enrolled in
- A list of other Medicare Prescription Drug Plans available to you
- A list of frequently asked questions and answers about your Medicare prescription drug coverage
What is Extra Help?
Extra Help is a federal program that helps pay for out-of-pocket costs related to a Medicare prescription drug coverage plan. It is also known as the Part D Low-Income Subsidy (LIS) and it is estimated to be worth about $4,900 per year. To qualify for Extra Help, your resources must be limited to $14,390 for an individual or $28,720 for a married couple living together in 2019.
To find out if you qualify for Extra Help, you will need to file an Application for Extra Help with Medicare Prescription Drug Plan Costs through the Social Security Administration. They’ll need to know the value of your income, savings, investments, and real estate (other than your home). If you are married and living together, you’ll also need to provide information about you and your spouse.
However, if you are enrolled in Medicaid, Supplemental Security Income, or a Medicare Savings Program, you automatically qualify for Extra Help and don’t need to apply to be a part of the program.
What Does Extra Help Cost?
If you qualify for the Extra Help program your monthly premium and deductibles for Medicare Part D will be reduced or eliminated completely. However, you may still be responsible for copayments for prescriptions covered by your plan.
What Do You Do If You Receive The Medicare Part D Auto-Enrollment Notice?
You should take the time to call the assigned Medicare drug plan to get information about your new drug coverage.
It’s possible that the plan may not cover all of your prescriptions or isn’t accepted at the pharmacy you use. If that’s the case, you may want to find a plan that better suits your healthcare needs.
You can find a list of alternative Medicare-approved plans conveniently included with your Part D Auto-Enrollment Notice.
What If You Want to Switch Part D Plans on Extra Help?
If you decide that the plan that was selected for you isn’t the right plan for you, you can — and should — switch to a plan that provides you with the coverage you need.
Since you qualify for Extra Help, you are not limited to a single enrollment period. You can join, switch or drop your Medicare Part D coverage one time during each of the following periods:
- January – March
- April – June
- July – September
Any changes you make will go into effect on the first day of the following month. If you are unhappy with this switch, you’ll have to wait until the next period to make another change.
If you’d like to make a change from October through December, you’ll have to do it during Medicare’s standard enrollment period, which is October 15 – December 7. Any changes made during that time will go into effect on January 1.
To switch to a different Medicare Part D plan, call the new provider to find out their requirements to join. Once you’ve successfully enrolled in a new plan, you don’t need to do anything else. You will be automatically disenrolled from your current plan. Your coverage will switch over at the beginning of the next month.
What If You Have Other Prescription Drug Coverage?
If you have (or are eligible for) another type of prescription coverage, it’s important for you to talk to your current plan provider to learn how joining a Medicare Drug Plan may affect your current coverage.
It’s possible that you may not need a Medicare Drug Plan. It’s also possible that, by making the switch to a Medicare Drug Plan, you and your dependents could completely lose coverage you are counting on.
Noe that if you are part of an employer or union plan and are getting the Retiree Drug Subsidy (RDS), you will not be automatically enrolled in a Medicare drug plan, even if you meet the requirements. Instead, you will receive a notice letting you know that you qualify for Extra Help that explains your options.
What If You Decide To Decline Medicare Part D Coverage?
You have the option to decline a Medicare Drug Plan completely. If you decide that you don’t want either the plan Medicare has selected for you or any other Medicare Drug Plan, you need to call Medicare and tell them you’d like to decline Medicare prescription drug coverage.
It’s important to note that you must have a drug plan to have most prescribed medications covered by insurance. So if you need prescription drugs and don’t have Medicare drug coverage, neither Medicare nor Medicaid will pay for most outpatient medications.
If you decline Medicare Part D coverage but then change your mind, you can re-enroll. As long as you are eligible for Medicaid, you can join a Medicare drug plan at any time throughout the year. But, if you lose your Medicaid eligibility, you may have to pay a penalty in order to rejoin.
Getting Independent Part D Help
It’s important that whatever decision you make about Medicare Part D is an informed one. If you’d like more information about your Medicare options there are plenty of ways you can get assistance. Call a licensed, independent agent via HealthCare.com at any time to find the answers to your Medicare questions. 💊
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