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Medicare Part D Coverage in Kentucky

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Beneficiaries looking for Medicare prescription drug coverage in Kentucky have a couple options when it comes to getting this benefit, also known as Medicare Part D. Your options will depend on whether you get your Medicare coverage through Original Medicare, the federally administered program, or through a Medicare Advantage plan.

Original Medicare, Part A and Part B, offers limited prescription drug benefits in certain inpatient and outpatient settings, but for most other prescription drugs, you’ll get coverage through Medicare Part D. If you have Original Medicare, you can get this coverage through a stand-alone Medicare Prescription Drug Plan. This coverage doesn’t come automatically when you enroll in Medicare; you must manually enroll in Medicare Part D.

Alternatively, you can get Medicare prescription drug benefits through Medicare Advantage plans that include this benefit. Also known as Medicare Advantage Prescription Drug plans, these Medicare plans are offered through private insurance companies that are contracted by Medicare to provide at least the same level of coverage as Original Medicare, Part A and Part B. Some Medicare Advantage plans may also cover benefits beyond Original Medicare, such as routine vision or dental, hearing, or prescription drugs. Not every Medicare Advantage plan covers prescription drugs, so double check with the Medicare Advantage plan you’re considering before enrolling.

Enrolling in Medicare Part D coverage in Kentucky

Like other parts of Medicare, there are rules for when you can enroll in Medicare Part D coverage in Kentucky.

You’re typically first eligible for Medicare Part D coverage when:

  • You have Medicare Part A and/or Part B, and
  • You live in the service area of a Medicare plan that covers prescription drugs.

Most beneficiaries are first eligible for Medicare Part D during their Initial Enrollment Period for Part D, which is the seven-month period that spans when you’re first eligible for Medicare. For many people, this period coincides with their Initial Enrollment Period for Part B and starts three months before their 65th birthday, includes their birthday month, and ends three months later. If you qualify for Medicare because you receive Social Security or certain Railroad Retirement Board disability benefits, then your Initial Enrollment Period for Part D will start three months before your 25th month of disability benefits and last seven months.

After you initial period of eligibility has passed, you’ll have to wait for the Annual Election Period to make changes to your prescription drug coverage. This is the period that occurs from October 15 to December 7 every year. During this time, you can:

  • Enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time.
  • Switch plans.
  • Disenroll from your Medicare Advantage plan and return to Original Medicare.
  • Disenroll from your Medicare Prescription Drug Plan.

If you use the Medicare Advantage Disenrollment Period (from January 1 to February 14) to disenroll from your Medicare Advantage plan and go back to Original Medicare, you can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan. You can only use this period to disenroll from your Medicare Advantage plan and add a Medicare Prescription Drug Plan; you cannot use this disenrollment period to make any other types of changes to your Medicare Part D coverage.

Outside of the above periods, you can only make changes to your prescription drug coverage in special circumstances, such as if you move out of your Medicare plan’s service area or if you move into, out of, or currently live in a nursing home. These are just a few examples of situations that may qualify you for a Special Election Period to make changes to your Medicare coverage.

Even if you aren’t yet taking prescription medications, you may want to consider enrolling in Medicare Part D coverage if you do not have other creditable prescription drug coverage (insurance that is expected to pay, on average, as much as the Part D benefit). If you don’t enroll in Medicare Part D when you’re first eligible and go without creditable prescription drug coverage for 63 consecutive days or more, you could face a late-enrollment penalty later if you do sign up for this coverage later on.

Choosing Medicare Part D coverage in Kentucky

Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans vary when it comes to the specific drugs covered, the amount of coverage provided, and the overall cost of the plan. Every Medicare plan that includes prescription drug coverage has a formulary, which is a list of medications covered by the plan. Before enrolling in any Medicare plan, it’s important to check the plan’s formulary to make sure that your prescription drugs are covered. Keep in mind that formularies may change at any time. Your Medicare plan will notify you if necessary.

Another factor to consider is that your costs may also vary, depending on the specific Medicare plan, even when the prescription drugs are the same. That’s because Medicare plans that cover prescription drugs usually separate covered medications into different cost “tiers.” Each tier comes with different levels of cost sharing, and medications on higher tiers tend to have higher copayments and coinsurance. Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans may place covered drugs into tiers differently, which is why your out-of-pocket costs can vary so much, even for the exact same medications. By taking the time to shop around and research Medicare plan options in your area, you may be able to save money by finding a Medicare plan that covers your medications at the lowest cost sharing.

Need help finding Medicare plan options that may fit your situation and cover your prescription drugs? Contact eHealth today, and a licensed insurance agent would be happy to discuss your Medicare needs with you.

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