It is important to sign up for a Medicare Part D Drug plan when you are first eligible. If you do not sign up when first eligible you will most likely have to pay a late penalty. If you have creditable drug coverage (coverage that is as good as or better than Medicare) you will not have a late penalty.
There are 2 ways to receive a Medicare Prescription Drug Plan or a Part D plan:
You can add drug coverage to Original Medicare (Part A and B is called Original Medicare)
You can get a Medicare Advantage Plan with drug Coverage. Advantage Plans are HMO’s or PPO’s you get your Part A and B and Drug Coverage through Advantage Plans
For more information or to enroll contact your State Health Insurance Assistance Program (SHIP) for Missouri the number is 1-800-390-3330.
2. What do I do if I am enrolled in a non-benchmark Medicare Plan, but found out that I am eligible to enroll into a “Benchmark” plan.
There are 4 benchmark plans in 2016 that a beneficiary receiving extra help can enroll. The premium for the benchmark plan will be zero and there is no deductible. If a beneficiary, who receives full extra help, enrolls in a non-benchmark plan then the premium will be reduced and the beneficiary will be required to pay that monthly premium.
Also, another important reason to work with a SHIP Counselor, and to have the Counselor enter the current drugs that the Beneficiary takes, is to make certain that all drugs are on the ‘Benchmark’ Plan’s Formulary!! Even though a Beneficiary is eligible and could enroll into a $0 Premium plan, if their drugs are not covered by the Benchmark Plan’s formulary, this could cause a much bigger issue. The cost of those drugs that are not covered, could end up causing the Beneficiary to pay a great deal of money out of pocket!
3. What do I do if I am already enrolled in Medicare, but also have employer-sponsored or other third-party insurance plan?
If a beneficiary, 65 years or older, is enrolled in Medicare while he/she is still working and is also enrolled in their employer sponsored plan, the employer plan will be primary to Medicare, in many cases. In order for this statement to be true for the employee and/or 65 year old spouse, there has to be 20 or more employees, and the beneficiary must still be actively working. If the employee (or spouse) is under the age of 65 and is enrolled in Medicare due to a disability, in order for the employer plan to be primary in this situation, there must be 100 or more employees. If the employer plan IS primary to Medicare, the beneficiary is able to delay Part B, or if already enrolled, could drop Part B, without incurring a penalty. While the employee is still working, he or she may sign up for Part B at any time. When the Beneficiary decides to end employment, they will then receive a Special Enrollment Period to enroll (or re-enroll) into Part B. This Special Enrollment Period will last up to 8 months after employment ends, or until the employer insurance ends, whichever comes first.
4. What do I do if I enroll in a Medicare plan and later have to make an adjustment because of a major life event?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. Almost all major life events will have a Special Enrollment Period (SEP). This will let you make the changes you need for Medicare coverage. Call to find out if a Special Enrollment Period can work for you.
5. What do I do if I want to change to a different Part D Plan?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. Have your Medicare card and list of medications ready.
6. What do I do if I need help paying for Medicare Part D Plan premiums, deductibles, and co-pays?
Medicare has a program called Extra Help to help reduce Part D premiums, deductibles, co-pays, and eliminate the coverage gap. This program is income & resource based, even if your income & resources are slightly higher than the limits, you are encouraged to apply.
You will need to check with your state to see if this program exists in your area.
You can find more information about this Program on the CLAIM website www.missouriclaim.org or by contacting your states’ State Health Insurance Assistance Program (SHIP). In Missouri the number is 1-800-390-3330
Missouri Rx is another program that can help save money on prescriptions. Missouri Rx covers 50% of the Medicare Part D “gap” and pays 50% of the Medicare Part D Co-pays.
This is the only assistance program that does not count your resources.
To learn more about this program contact your local State Health Insurance Assistance Program (SHIP), go to our website Missouriclaim.org.
7. Who do I contact to help me enroll in a Part D Plan?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. Have your Medicare card and list of medications ready. The SHIP volunteer will help you choose the best plan for you based on your current medications, pharmacy of choice, least restrictions and best prices.
8. Who do I contact for information about Long Term Care assistance?
To obtain the most accurate and helpful information regarding Long Term Care Insurance, I would start with Missouri Department of Insurance. The department’s website is http://insurance.mo.gov/consumers/LongTerm. On this site you will find information such as Frequently Asked Questions, Long Term Care Costs, and a variety of additional links and resources.
9. Who can I contact to learn more about Medicare enrollment and benefits?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. We refer your call to a trained SHIP counselor in your area who will know the local program(s) you seek. We have 300 counselors statewide to help you.
10. What happens if I miss the enrollment deadline? What do I do?
Call your local SHIP program. The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. We will evaluate your situation and see if you might qualify for a Special Enrollment Period. No promises but we will try!