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Medicare Part D Plans in New York


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About Medicare Part D coverage in New York

If you’re a Medicare beneficiary in New York, you may be wondering about your Medicare coverage options. When it comes to Medicare prescription drug coverage (Medicare Part D), there are a few ways to get this coverage, depending on whether you’re enrolled in Original Medicare, Part A and Part B, or a Medicare Advantage plan.

Original Medicare, Part A and Part B, does not provide prescription drug benefits except in certain situations. Medicare Part A covers any medications you get during an inpatient hospital or skilled nursing facility stay, while Medicare Part B covers prescription drugs that you get in an outpatient setting, like a doctor’s office. Medications covered by Medicare Part B tend to be the type you can’t give yourself, like vaccines or medications given by infusion. For coverage beyond this, you’ll need to enroll in Medicare Part D.

Original Medicare beneficiaries can get prescription drug coverage by enrolling in a Medicare Prescription Drug Plan (PDP). These plans provide stand-alone coverage that works alongside your Medicare Part A and Part B benefits and are offered through private insurance companies that are approved by Medicare.

Another option is to enroll in a Medicare Advantage Prescription Drug (MAPD) plan, which combines health insurance and the Medicare Part D benefit into one comprehensive plan. Medicare Advantage (Medicare Part C) plans are also available through private insurance companies; these plans are required to cover at least the same level of coverage that you’d have under Original Medicare, Part A and Part B. However, some Medicare Advantage plans may also cover additional benefits, including wellness programs, hearing, routine vision or dental, and prescription drugs. If you’re enrolled in Medicare Part C and want prescription drug coverage, you should enroll in a Medicare Advantage Prescription Drug plan, not a Medicare Prescription Drug Plan.

Enrolling in Medicare Part D coverage in New York

When it comes to most types of Medicare coverage, there are rules surrounding when you’re eligible and when you can enroll; Medicare Part D is no exception. New York beneficiaries, like individuals in the rest of the country, are eligible for Medicare Part D when they:

  • Have Medicare Part A and/or Part B, and
  • Live in the service area of a Medicare plan that includes prescription drug coverage.

If you’re interested in signing up for Medicare Part D benefits, you can do so during the following periods:

  • Initial Enrollment Period (IEP) for Part D: This is when you’re first eligible for Medicare Part D and typically coincides with when you’re first eligible for Medicare. If you qualify for Medicare because of age, your IEP for Part D is usually the same as your seven-month Initial Enrollment Period for Part B, starting three months before you turn 65, including your birthday month, and ending three months later. If you get Medicare because of disability, your Initial Enrollment Period for Part D starts three months before your 25th month of disability benefits from Social Security or the Railroad Retirement Board and lasts seven months.
  • Annual Election Period (October 15 to December 7): If you missed your IEP for Part D or if you signed up but would like to make changes, your next chance to do so is the Annual Election Period (or Fall Open Enrollment Period). During this time, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time. If you already have prescription drug coverage, you can switch Medicare plans or disenroll from your plan.
  • Medicare Advantage Disenrollment Period (January 1 to February 14): If you are enrolled in a Medicare Advantage plan but would like to return to Original Medicare, you can use this period to do so. If you disenroll from your Medicare Advantage plan, you can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan.
  • Special Election Period: Outside of the above periods, you can only make changes to your Medicare Part D coverage if you’re eligible for a Special Election Period. Examples of situations that may qualify include, but aren’t limited to, moving out of your Medicare plan’s service area, losing your Medicaid eligibility, or moving into a nursing home.

How to compare Medicare Part D coverage in New York

Since Original Medicare, Part A and Part B, offers limited prescription drug coverage, it is important to enroll in Medicare Part D coverage that will help cover the costs of eligible medications. Even if you currently do not currently take prescription drugs, it is a good idea to sign up for Medicare Part D as soon as you’re first eligible if you don’t have other creditable prescription drug coverage (insurance that is as good as the standard Part D benefit). If you don’t have Medicare Part D and go without creditable prescription drug coverage for 63 consecutive days or more, you could face a late-enrollment penalty for Part D if you enroll later on.

Keep in mind that benefits, costs, and availability of Medicare plan options may vary depending on your county of residence. Each Medicare plan that includes prescription drug coverage has a formulary, or list of medications covered by the plan. It’s a good idea to check the plan formulary to make sure your medications are covered before enrolling in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan. The formulary may change at any time. You will receive notice from your plan when necessary.

Do you need help finding Medicare plan options in New York? An eHealth licensed insurance agent would be happy to discuss your Medicare needs with you to find the coverage options that may fit your situation.

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