Understanding Medicare Part D Plans

Understanding Medicare Part D Prescription Drug Coverage

Whether you’re new to Medicare, of if you’ve been enrolled in a plan, we’re here to help you make sense of it all.

What is Medicare Part D Prescription Drug Coverage?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future. Our affordable Medicare Part D Prescription Drug Plans offer you coverage on medicines not covered under Medicare Part B.

Eligibility for Medicare Part D Prescription Drug Coverage

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

When You Can Get Medicare Part D Prescription Drug Coverage

• You may sign up when you first become eligible for Medicare (three months before the month you turn 65, during the month you turn 65, and three months after.) This is your Initial Enrollment Period.
• If you have Medicare because of a disability, you can join from three months before to three months after your 25th month of Social Security Disability Payments.
• If you don't sign up when you are first eligible, you may pay a late enrollment penalty.
• If you didn't join when you were first eligible, your next opportunity to join will be from November 15 to December 31. This is Medicare’s Annual Enrollment Period.

How To Get A Plan With Medical Coverage, Too

• If you need coverage for doctors’ and hospital visits AND prescription drug coverage, you may be interested in a Medicare Advantage plan with integrated prescription drug coverage (called MA-PD plans).
• Medicare Advantage plans from Universal American can provide you complete coverage for one low monthly payment. Find out more about plans in your area by using out Medicare plan finder.

How To Receive Extra Help

You may qualify for Extra Help to pay for your Medicare prescription drug plan premiums and costs. To see if you qualify for getting Extra Help, call:

• Medicare at 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week.
• Social Security Administration at 1-800-772-1213 between 7a.m. and 7p.m., Monday through Friday (TTY users should call 1-800-325-0778).
• Your state Medicaid office for more information.

Background on Best Available Evidence Policy

Best Available Evidence (BAE) policy is used when the low-income subsidy information in Centers for Medicare & Medicaid Services' (CMS) systems is not correct. CMS relies on monthly files from the states and Social Security to establish an individual’s low-income subsidy deemed eligibility and appropriate cost-sharing level. In certain cases, CMS systems do not reflect a member’s correct LIS deemed status. This may occur, for example, because a state has been unable to successfully report the beneficiary as Medicaid eligible or is not reporting him/her as institutionalized.

Best Available Evidence is a document that shows you qualify. Once the Plan validates the Best Available Evidence with Medicaid/Medicare, we will update your Low Income Subsidy Assistance status as quickly as possible.

For more information on Low income subsidy and BAE, you may visit the policy on the Medicare Web site (by clicking on this link you are leaving the Universal American Web site).