Medicare Part D Coverage in Michigan
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In Michigan, like the rest of the United States, Medicare Part D coverage is available through private insurance companies approved by Medicare to help beneficiaries with prescription drug costs. You can get this coverage through either a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. The way you get prescription drug coverage will depend on how you’re getting your Medicare Part A and Part B coverage and whether you’re enrolled in Original Medicare or a Medicare Advantage plan.
If you’re enrolled in Original Medicare, Part A and Part B, keep in mind that prescription drug benefits are limited. You’ll be covered for certain medications you get as an inpatient during a hospital stay or in a doctor’s office; however, for the majority of prescription drugs, you’ll need to be enrolled in Medicare Part D. Medicare prescription drug coverage is available for Original Medicare beneficiaries as stand-alone coverage through a Medicare Prescription Drug Plan.
Medicare Part D coverage works differently if you’re enrolled in a Medicare Advantage plan, also known as Medicare Part C. Medicare Advantage plans are an alternative to the federal program and must 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, including hearing, wellness programs, routine vision or dental, and prescription drugs. If you have Medicare Part C, you can get prescription drug coverage through a Medicare Advantage Prescription Drug plan. Keep in mind that not every Medicare Advantage plan includes prescription drug benefits, so check with the specific plan before enrolling.
Enrolling in Medicare Part D coverage in Michigan
Michigan beneficiaries are eligible for Medicare Part D if they:
- Have Medicare Part A and/or Part B and
- Live in the service area of a Medicare plan that covers prescription drugs
Like other parts of Medicare, you’re only allowed to enroll in or make changes to your Medicare prescription drug coverage during specific times. These periods include:
- Initial Enrollment Period for Part D: This is the seven-month period when you’re first eligible to sign up for Medicare Part D, and it typically coincides with the period that you’re first eligible for Medicare coverage. If you get Medicare because of age, this period starts three months before you turn 65, includes the month you turn 65, and ends three months later. If you get Medicare because of disability, this period starts three months before the 25th month of disability benefits from Social Security or the Railroad Retirement Board, includes the 25th month, and ends three months later.
- Annual Election Period (October 15 to December 7): This is your yearly opportunity to enroll in a Medicare plan or make changes to your coverage. During this period, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switch plans, or disenroll from a Medicare plan.
- Medicare Advantage Disenrollment Period (January 1 to February 14): During this period, you can disenroll from a Medicare Advantage plan and return to Original Medicare. If you use this period to disenroll from your Medicare Advantage plan, you’ll also have the chance to enroll in a Medicare Prescription Drug Plan. You can’t make any other types of changes to your Medicare coverage.
- Special Election Period: Outside of the above periods, you can only make changes to your Medicare prescription drug coverage in certain situations that qualify you for a Special Election Period. This may include (but isn’t limited to) a change of address, losing your Medicaid eligibility, or living in a nursing home. A Special Election Period can occur at any time of the year that you have a qualifying situation.
Choosing Medicare Part D coverage in Michigan
Because Medicare Part D coverage is offered through private insurance companies approved by Medicare, the benefits, costs, and plan availability will depend on location. The county you live in may determine your costs and the specific Medicare plan options you have available to you. As a Michigan beneficiary, it’s important to consider all your plan options before you make a final decision.
As you research your coverage options, one important factor to keep in mind is that Medicare plans that cover prescription drugs may vary when it comes to their drug tiers. Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans place covered prescription drugs into tiers, with different cost sharing for the medications on each tier. Prescription drugs that fall under higher tiers have higher copayments and coinsurance costs than medications on lower tiers.
In addition, Medicare plans that cover prescription drugs can vary when it comes to their formularies, which are a list of prescription drugs covered by the plan. The formulary may change at any time. You will receive notice from your plan when necessary.
Because each Medicare plan varies when it comes to cost tiers and formularies, this means that a Medicare beneficiary in Michigan may pay one price for a certain prescription drug under one Medicare plan, but another plan may not cover the medication at all or may have different costs. Because of this, it’s a good idea for beneficiaries to take their individual prescription medication needs into consideration when researching Medicare plan options in their county.