Medicare Part D

Medicare Part D enrollment

Enrolling in Part D means that you are adding prescription drug coverage to your original Medicare plan (Medicare Parts A and B) or to your private fee-for-service plans. Enrolling in a Medicare Prescription Drug Plan can save you money, should your prescription drug costs rise in the future. You should enroll in a Medicare Prescription Drug Plan, unless your current drug coverage is as good as, or better than, the Medicare Prescription Drug Coverage available to you. It’s important that you join a plan when you are first eligible. If you are eligible for Medicare and have Medicaid, you may be automatically enrolled in a prescription drug plan. Check with your State Medicaid Department for more information.

Eligibility for Medicare Part D

You can participate in Medicare Part D if you:

*Are 65 years or older and eligible for Social Security
*Are under 65, permanently disabled, and have received SSI disability payments for at least two years
*Are receiving continued dialysis for permanent kidney failure or need a kidney transplant
*Have Amyotrophic Lateral Sclerosis (ALS-Lou Gehrig’s disease)
Questions about Medicare Part D?

Call 1-800-MEDICARE (1-800-633-4227) or visit Your local Health Mart pharmacist is also available to answer any questions you may have.

Medicare Part D FAQs

Is Medicare Part D right for you?

The Medicare Part D drug benefit was created to be an insurance plan that can help you as a Medicare beneficiary, cover drug costs if you become sick, or increase the number of prescription drugs you are taking. You already may have sufficient coverage under your current healthcare coverage, so check with your current plan’s benefits administrator to find out how – or if – the Medicare Part D drug benefit is right for you. For help with deciding whether to enroll in Part D, and choosing the plan best suited for your needs, talk to your local Health Mart pharmacist.

Do I have to sign up for Part D?

No. Medicare Part D is a voluntary prescription drug program option offered by Medicare. However, if you do not enroll when you first become eligible for Medicare, and you want to take advantage of the Part D drug benefit at a later time, your monthly premiums may be higher if you did not have other prescription coverage considered equivalent (“creditable”) to the standards of the Part D benefit.

However, Medicare waived this penalty in 2007 for people who apply and qualify for the “Extra Help” program through the Social Security Administration. This program pays most or all of premiums, co-payments, and deductibles related to Medicare Part D for people with limited incomes and resources.

What is a formulary?

A formulary, also known as a “preferred drug list,” is the list of drugs covered by Medicare Part D plans and available to program enrollees. Before you enroll in a Part D plan, you will want to check the plan’s formulary to make sure all of the prescription drugs you need are on the list. Ask your Health Mart pharmacist for assistance in determining if a Part D plan will meet your prescription drug needs. Or, try the “Formulary Finder for Prescription Drug Plans” tool on

What if another plan pays for my drugs during the coverage gap?

The provider of your other drug insurance will work with your Medicare drug plan to ensure you receive the correct coverage. However, not all extra coverage counts towards the out-of-pocket maximum, which means you could take longer to qualify for catastrophic coverage. Drug costs that DO count toward the out-of-pocket maximum include those paid for by a family member and some state pharmacy assistance programs. Those that DO NOT count include costs paid by other insurance, including workers compensation or military retiree benefits.

How are my out-of-pocket expenses in the Medicare coverage gap tracked?

If you continue to get drugs through your Medicare drug plan during the Part D coverage gap, or “donut hole,” the plan will keep track of your spending. However, if you get your prescription drugs elsewhere, you will need to send the receipts to your plan.

Note: Only drugs covered by your Part D plan will count toward the $3,850 out-of-pocket maximum. Once the maximum is reached, your plan automatically starts your catastrophic coverage.

How much does Medicare Part D cost?

Your Part D costs will vary depending on:

*Which prescription drugs you use
*Which Medicare drug plan you use
*Whether you receive extra help paying for your Part D costs (such as through the Social Security Administration’s “Extra Help” program)

How do I know if I qualify for Part D?

You qualify for Part D if you are over 65 years old and permanently disabled, and are eligible currently for Medicare Part A or enrolled in Medicare Part B.

I don’t take prescription drugs. Do I need Part D?

The Centers for Medicare and Medicaid Services (CMS) advises that you enroll in a Part D plan even if, at this time, you don’t use prescription drugs at all, or only rarely. That’s because joining as soon as you are eligible likely will mean that you will pay the lowest monthly premium for the benefit. Plus, the likelihood that an individual will use prescription dugs increases with age, so you might want to think about preparing now for your future needs. Think of the Part D benefit as a type of insurance, to use in the future in case you become sick or begin taking one or more prescription medications.

To find the actual costs of the Medicare drug and health plans in your area, ask your Health Mart pharmacist, or go to the “Compare Medicare Prescription Drug Plans” tool on Medicare’s Web site.

When am I eligible for Medicare?

You become eligible for Medicare when you turn age 65. If you have certain disabilities and are under age 65, or if you have end-stage renal disease (kidney failure), you may also be eligible for Medicare.

Where can I get more information?

For more information, call 1-800-MEDICARE (1-800-633-4227) or visit Your local Health Mart pharmacist is also available to answer any questions you may have.

Questions about billing?