About Medicare Part D

Medicare Basics

Understanding how Medicare works can help you make an informed decision about which SilverScript prescription drug plan is right for you.

What is Medicare?

Medicare is health insurance administered by the federal government

  • For people who are 65 or older
  • If you have a qualifying disability for which you have been receiving Social Security Disability Insurance (SSDI) for more than 24 months1
  • If you have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring a kidney transplant or dialysis)
  • If you are entitled to Medicare Part A and/or enrolled in Medicare Part B

Medicare's Four Parts

Medicare Part

What it Covers

Description of Coverage

Part A

Hospital Coverage

- Inpatient hospital care
- Inpatient stays at most skilled facilities
- Home health and Hospice care

Part B

Medical Coverage

- Doctor and clinical lab services
- Outpatient and certain preventive care
- Screenings, surgical fees and supplies
- Physical and occupational therapy
- Limited outpatient prescription drugs

Part C
(Medicare Advantage)

Combines Part A and Part B, and may include Part D

A different way of getting Medicare Part A and Part B coverage. Medicare Advantage plans (MA) combine Part A and Part B together in one plan. MA plans can also be combined with a Part D prescription drug benefit for complete Medicare coverage, called Medicare Advantage Prescription Drug (MA-PD) plans.

Generally, these Medicare Advantage plans are offered as:
- Preferred Provider Organizations (PPO)
- Health Maintenance Organizations (HMO)
- Private Fee-for-Service Plans (PFFS)

Part D

Prescription Drug Coverage

Available as stand-alone coverage, and also as a prescription drug benefit added to a Medicare Advantage Prescription Drug Plan (MA-PD).

Medicare Part D

Whether you're new to Medicare, or already enrolled in a Medicare plan, we're here to help you understand Medicare Prescription Drug Plans.

What is Medicare Prescription Drug Coverage (Medicare Part D)?

Medicare Part D is a federal program that helps people with Medicare pay the costs of prescription drugs. It was enacted as part of the Medicare Modernization Act of 2003 and went into effect January 1, 2006. Medicare Part D is administered by private insurers approved by Medicare. SilverScript prescription drug plans are Medicare approved, and offer formularies (list of covered drugs) that are designed specifically for people with Medicare.

Am I eligible for Medicare Prescription Drug Coverage?

  • You are eligible to enroll in a Medicare Prescription Drug Plan if you are entitled to Medicare benefits under Medicare Part A and/or enrolled in Medicare Part B.
  • At any given time, you may only be enrolled in one plan that provides Medicare prescription drug coverage.

When can I enroll in a Medicare Prescription Drug Plan?

  • If you are eligible for Medicare because you are turning 65, you may enroll three months before the month you turn 65, during the month of your 65th birthday, and three months after the month you turn 65. This time period is your Initial Enrollment Period (IEP)2.
  • If you are eligible for Medicare due to disability, you may enroll in Medicare prescription drug coverage three months before your 25th month of Social Security Disability Payments and up to three months afterward.
  • If you choose not to enroll in a Medicare prescription drug plan when you become eligible—and do not have creditable drug coverage (coverage as good as Medicare coverage)—you may have to pay a Part D late enrollment penalty.

How can I receive Extra Help from Medicare?

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, or
  • Social Security Administration 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.

1 During the 7-month period that starts 3 months before your 25th month of getting Social Security or RRB disability benefits and ends 3 months after your 25th month of getting disability benefits. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.

2 Your IEP is the 7-month period that begins three months before your 65th birthday, includes your birthday month and ends three months afterward. There is an exception if your birthday falls on the first of any month, your 7-month IEP begins and ends one month sooner. For example, if your birthday is July 1, your 7-month IEP is the same as if you were born in June— beginning in March and ending in September.

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