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Medicare Part D Plans in North Carolina

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About Medicare Part D in North Carolina

Original Medicare (Part A and Part B) covers a variety of hospital and medical services for eligible Medicare beneficiaries. However, when it comes to prescription drug coverage, Original Medicare offers limited benefits. You’ll be covered for any prescription drugs you receive as part of a covered inpatient stay or in an outpatient setting (such as a doctor’s office). However, for most other prescription medications, you’ll need to sign up for Medicare Part D to get help paying for medication costs.

North Carolina beneficiaries have a few options when it comes to Medicare prescription drug coverage. If you have Original Medicare (Part A and Part B), you can get Medicare Part D coverage by enrolling in a stand-alone Medicare Prescription Drug Plan. These plans are offered through private insurance companies approved by Medicare and help cover some of the costs of eligible prescription medications.

Another option is to enroll in a Medicare Advantage Prescription Drug plan and get all of your health and prescription drug coverage through a single plan. Medicare Advantage (Medicare Part C) plans are an alternative way to receive your Original Medicare coverage; instead of getting your Medicare benefits through the federal program, your Medicare Advantage plan administers your Medicare coverage. These plans are required to cover at least the same level of benefits as Original Medicare, but may also cover additional benefits, such as routine vision or dental, wellness programs, or prescription drugs.

Enrolling in Medicare Part D in North Carolina

North Carolina beneficiaries who would like to sign up for Medicare prescription drug coverage can do so during certain times. In North Carolina, as in the rest of the country, you’re eligible for Medicare Part D if:

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

You’re first eligible for Medicare Part D during your Initial Enrollment Period (IEP) for Part D, which typically takes place at the same time that you’re first eligible for Medicare coverage. If you qualify for Medicare because of age, your IEP for Part D will coincide with your Initial Enrollment Period for Part B, starting three months before you turn 65, including the month you turn 65, and ending three months later. If you qualify for Medicare because of disability, then your IEP for Part D will start three months before your 25th month of receiving disability benefits from Social Security or the Railroad Retirement Board, then continue for seven months.

If you miss your Initial Enrollment Period for Part D or if you enrolled in Part D but would like to make changes, you can do so during the Annual Election Period (AEP), also called the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, from October 15 to December 7 of every year. During this period, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time. If you already have Medicare Part D, you can switch Medicare plans or disenroll from your plan.

If you have Medicare Part C, but change your mind and want to return to Original Medicare, you can use the Medicare Advantage Open Enrollment Period (OEP), from January 1 to March 31, to disenroll from your Medicare Advantage plan. Then you can sign up for a stand-alone Medicare Prescription Drug Plan during the OEP

During this OEP, you can also change from one Medicare Advantage plan to another.

You typically cannot make changes to your Medicare Part D coverage outside of the above periods unless you qualify for a Special Election Period. Some types of situations that may qualify you for a Special Election Period include living in a nursing home, moving out of your Medicare plan’s service area, or becoming eligible for Medicaid.

Compare Medicare Part D coverage in North Carolina

As you research and compare Medicare Part D coverage options in North Carolina, it’s important to remember that availability and cost may depend on your county of residence. 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. In addition, each Medicare plan that includes prescription drug benefits can determine which specific medications to cover; this information can be found in the plan’s formulary, which is 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.

As mentioned, there can be huge differences from plan to plan when it comes to the precise medications covered and your out-of-pocket costs. If you like, you can start shopping and comparing Medicare plan options right now from the convenience of your home. All you need to do is enter your zip code in the plan finder tool on this page to see a customized list of Medicare plan options available to you in your area. You can also enter your current prescription drugs to help narrow your search to Medicare plans that cover your medications. Or, if you prefer to get help over the phone, you can contact eHealth to discuss your Medicare needs with a licensed insurance agent.

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