How to Apply for Medicare Part C and D
If you’re navigating the potential options for Medicare, you may wonder how to apply for Medicare Part C and D.
This article will cover eligibility requirements, critical enrollment windows, and the steps to apply for Medicare Part C (Medicare Advantage) and Part D (Prescription Drug Coverage).
Key Takeaways
- Medicare Part C (Medicare Advantage) will likely provide comprehensive coverage, which may include benefits not offered by Original Medicare, but enrollment requires having Part A and Part B and can depend on timing with specific enrollment periods.
- Medicare Part D covers prescription drugs and may be available to all individuals with Medicare, with the choice of pharmacies possibly impacting copayments.
- Choosing between Medicare Supplement Insurance (Medigap) and Medicare Advantage will likely require a consideration of potential factors such as additional benefits, provider flexibility, out-of-pocket costs, and the implications of switching plans.
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Understanding Medicare Part C (Medicare Advantage)
Medicare Advantage plans, also known as Part C, could serve as an alternative to Original Medicare, potentially offering comprehensive coverage and additional benefits. These plans will likely be offered by private insurance companies and cover all the benefits that Original Medicare provides.
Some Medicare Advantage plans may also include coverage for:
- Prescription drugs
- Dental services
- Vision services
- Hearing services
Unlike hospital insurance, Original Medicare might not provide comprehensive medicare coverage for preventive services.
Some Medicare Advantage plans may also be designed for enrollees with chronic conditions, possibly providing focused treatment and services tailored to their needs.
While Medicare Advantage must cover almost all the medically necessary services that Original Medicare covers, certain services, like clinical trials and hospice care, may not be included.
Step-by-Step Enrollment Process for Medicare Part C
Enrolling in a Medicare Advantage Plan begins with the initial enrollment period, which starts three months before your 65th birthday and extends three months after, including the month of your birthday. Ensuring a timely enrollment is vital to avoid possible coverage delays.
If you miss the initial enrollment period, you still have the chance to enroll or modify your Medicare Advantage plan during the annual open enrollment from October 15 to December 7. An additional Medicare Advantage open enrollment period is available for existing members from January 1 to March 31.
Special Enrollment Periods come into effect under certain circumstances like relocation or loss of current coverage. During these situations, a two-month window is provided from the event to enroll in or switch Medicare Advantage Plans.
Eligibility for a Medicare Advantage Plan requires enrollment in both Medicare Part A and Part B. Your plan coverage initiation is dependent on your enrollment timing, either before or after your Medicare begins.
To enroll, call one of our licensed agents at 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST. They can provide comprehensive information, personalized guidance, and ongoing assistance to navigate the enrollment process for private insurance companies, making it easier for beneficiaries to make informed decisions about their healthcare.
Introduction to Medicare Part D (Prescription Drug Coverage)
Medicare Part D is optional insurance that has been designed to help pay for prescription drugs. This coverage may be available to everyone with Medicare, possibly making it a vital tool for maintaining health and managing chronic conditions.
For eligibility, individuals must be enrolled in Medicare Part A and Part B and be a U.S. citizen or lawfully present in the United States.
Medicare Part D coverage might be integrated into certain Medicare Advantage plans. However, for those with Medigap policies, separate Part D plans may also be available.
Medicare Part D plans:
- are administered by private insurance companies
- beneficiaries could browse available plans by consulting independent insurance brokers
- beneficiaries could potentially choose up to five pharmacies to fill their prescriptions, with some plans offering lower copayments for preferred pharmacies.
Step-by-Step Enrollment Process for Medicare Part D
Using this website could potentially simplify the Medicare Part D enrollment process. Simply input your zip code into any of the zip code boxes to compare the various Part D plans, and review the formulary, cost, and coverage options.
Personal details may also be required, along with information about any medical expense assistance you might receive.
You may also need to include:
- Your drugs’ names
- Dosages
- Quantities
- Refill frequency
- Preferred pharmacies
To enroll, call one of our licensed agents at 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST. After enrolling in your medical insurance, you might want to set up monthly premium payments with the insurance company.
Payments could be billed, automatically deducted from your bank account, or taken out of your Social Security benefits or Railroad Retirement Board payments.
Choosing Between Medicare Supplement Insurance and Medicare Advantage
When choosing between Medicare Supplement Insurance and Medicare Advantage, there may be several factors to consider. Medicare Supplement (Medigap) plans will likely cover copays and out-of-pocket costs that might not be covered by Original Medicare.
Medigap may offer the flexibility to see any healthcare providers in the U.S. that accept Medicare without needing a referral. However, enrollment in both a Medicare Advantage plan and a Medigap policy simultaneously is not allowed.
Some of the Medicare Supplement plans may also come with predictable out-of-pocket costs, possibly facilitating easier budgeting. However, some plans might be costlier in terms of premiums when compared to Medicare Advantage plans.
When deciding on a plan, a member may want to consider their potential healthcare needs and the possibility of medical underwriting or denial based on health status when switching from a Medicare Advantage to a Medigap plan.
Tips for Navigating Medicare Enrollment
Navigating Medicare enrollment might be tricky, as members should be aware that joining or changing Medicare drug plans could affect their current health coverage.
This may be true for certain Medicare Advantage Plans, which might result in being returned to Original Medicare.
Beneficiaries with higher incomes might face a high-income surcharge on Part D premiums. Early enrollment in a Part D plan may be advisable to prevent future premium penalties, irrespective of whether you currently take prescription drugs or not.
If you delay Part D enrollment and decide later that you need drug coverage, you could face a premium penalty for the period you were without Part D coverage.
When searching for a Medicare broker, you might want to seek recommendations from friends or acquaintances.
Medicare brokers could help select plans potentially at no extra cost to you since they may be compensated through insurance company commissions. Members should use the National Association of Benefits and Insurance Professionals’ online tool to find a qualified broker in your area.
Members may also want to evaluate their past year’s Medicare experiences, considering possible factors such as customer service, drug coverage, and the acceptance of their plan by their doctor.
If eligible for Medicaid and Medicare Part D, you may be automatically enrolled in a Part D plan without a premium. You could opt out by contacting your local Medicaid office.
Those with low incomes should check if they qualify for the federal Extra Help program might assist with Part D premiums, deductibles, and copayments.
Summary
Understanding the potential nuances of Medicare enrollment may be crucial for making informed decisions about your healthcare coverage. Whether you opt for a Medicare Advantage Plan, Medicare Part D, or a Medicare Supplement plan, ensure it aligns with your healthcare needs and budget.
Remember to consider the long-term implications and seek advice from trusted advisors when necessary.
Frequently Asked Questions
→ Can you have both Medicare Part C and Part D?
Yes, you can have both Medicare Part C and Part D. Some of the Medicare Advantage (Part C) plans may offer prescription drug coverage (Part D) alongside additional benefits.
→ Can you add Medicare Part D at any time?
You can typically enroll in Medicare Part D during your Initial Enrollment Period or Special Enrollment Period, as long as you have Part A and Part B.
Other enrollment opportunities may also be available, such as during the Medicare Advantage Open Enrollment Period or the annual Medicare enrollment period.
→ What makes you eligible for Medicare Part D?
You are eligible for Medicare Part D if you are enrolled in Medicare, which is the national health insurance program for individuals aged 65 and older, as well as certain younger individuals with disabilities.
→ What additional benefits could Medicare Advantage plans provide?
Some Medicare Advantage plans may provide additional benefits such as coverage for prescription drugs, dental, vision, and hearing services, and some plans may be tailored for individuals with chronic conditions.
→ When can I enroll in Medicare Part C?
You can enroll in Medicare Part C during the initial enrollment period, which starts three months before your 65th birthday and extends three months after, including the month of your birthday.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.