Medicare Part D Frequently Asked Questions

Q: Am I eligible for a Medicare Part D Prescription Drug Plan?*

You must be entitled for Medicare benefits under Medicare Part A and/or enrolled in Medicare Part B to be eligible for our Part D plans. Please note that you can only be enrolled in one Medicare prescription drug plan at a time.

Medicare beneficiaries are entitled to enroll in or switch their Medicare Prescription Drug Coverage (Medicare Part D) between November 15 and December 31, for an effective date January 1st. There are other times when you may be able to sign up or switch prescription drug plans.

There are other times when you may be able to sign up or switch prescription drug plans. If you are turning 65 and are new to Medicare, you can enroll in a plan up to three full months before your birth month and up to three months after. If you are enrolled in Medicare and Medicaid, you can switch at any time.

Q: What drugs are excluded from the Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug Plans (MA-PD)?

The drugs that are excluded by Medicare are:

• Medications used to treat anorexia, weight loss, or weight gain
• Medications used to promote fertility
• Medications used for cosmetic purposes or hair growth
• Medications used to treat erectile dysfunction
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparation
• Non-prescription drugs
• Outpatient medications for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale

In addition, if a medication is covered by Medicare Parts A or B, it cannot be covered under Part D (Medicare Advantage Plans with Prescription Drug or Medicare Prescription). Some examples of Parts A or B medications include: diabetic test strips, injectables solely administered in the physician’s office and medications administered in the hospital. Also, each Medicare Advantage Prescription Drug Plan and Medicare Prescription Drug Plan may have its own specific exclusions.

Q: What if I don’t become eligible for Medicare until after December 31 of this calendar year?

No problem! Medicare will inform you of the dates of your seven-month open enrollment period, which is the same as your enrollment period for Medicare.

Q: Can I switch Medicare Advantage or Medicare Part D plans if I’m already enrolled in another Medicare prescription drug plan?

Yes. Generally speaking, most people are allowed to switch Medicare drug plans between November 15 and December 31 each year for an effective date of January 1st.

*Part D Enrollment Reminder:
Part D Medicare Beneficiaries enrolled in an MA PFFS plan that includes Medicare prescription drugs or any MA coordinated care (HMO or PPO) plan will be automatically disenrolled from the HMO, PPO or MA PFFS plan if they enroll in a PDP; and

Part D Medicare Beneficiaries enrolled in a private fee-for-service plan (PFFS) that does not include Medicare prescription drug coverage, an MA Medicare Savings Account (MSA) plan or an 1876 Cost plan may enroll in a PDP and will not be automatically disenrolled from the PFFS, MSA or 1876 Cost plan.