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Medicare Part D Prescription Drug Plans in Montana
If you're a Medicare beneficiary in Montana looking for prescription drug coverage, you'll have a couple options, depending on how you get your Medicare Part A and Part B benefits.
Original Medicare beneficiaries can enroll in stand-alone coverage with a Medicare Prescription Drug Plan, offered by private insurance companies that are approved by Medicare. Original Medicare (Part A and Part B) offers limited prescription drug coverage, and you'll need to enroll in Medicare Part D for coverage of most prescription medications. This coverage doesn't happen automatically; you need to manually enroll in a separate Medicare Prescription Drug Plan that works alongside your Part A and Part B benefits.
The Medicare Part D benefit is also available through a Medicare Advantage Prescription Drug (MAPD) plan, which combines health insurance and prescription coverage under one plan. Medicare Advantage plans, under the Medicare Part C program, are another way to get your Medicare Part A and Part B benefits; the difference is that instead of getting your Medicare benefits through the federal program, you'll get them directly through your Medicare Advantage plan (such as an HMO or PPO). By law, Medicare Advantage plans must cover at least the same level of benefits as Original Medicare. However, some plans may cover additional benefits, which may include wellness programs, routine vision or dental, and prescription drugs.
If you have Medicare Part C and want prescription drug coverage, you may want to switch to a Medicare Advantage plan that includes this benefit. Not every Medicare Advantage plan covers prescription drugs, so be sure to check that the plan you're considering does. Also, keep in mind that you shouldn't enroll in a stand-alone Medicare Prescription Drug Plan if you're already enrolled in a Medicare Advantage Prescription Drug plan; in fact, doing so may automatically disenroll you from your Medicare Advantage plan and return you to Original Medicare. So it's important to understand how Medicare Part D works and how certain actions may affect your Medicare coverage.
Enrolling in Medicare Part D coverage in Montana
To be eligible for Medicare Part D, you must:
Be enrolled in Medicare Part A and/or Part B, and
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 for Part D, which typically coincides with your Initial Enrollment Period for Part B. If you qualify for Medicare by age, this seven-month 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, it starts three months before your 25th month of disability benefits from Social Security or the Railroad Retirement Board and lasts seven months.
After your Initial Enrollment Period has passed, your next opportunity to make coverage changes is the Annual Election Period, which runs from October 15 to December 7 of each year. During this time, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switch Medicare plans, or disenroll from a plan.
If you use the Medicare Advantage Disenrollment Period (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 (since Original Medicare doesn't include Medicare Part D coverage). These are the only coverage changes you can make during this period.
After the above periods have passed, you can only make changes to your Medicare Part D coverage in certain situations that qualify you for a Special Election Period. For example, if you lose your Medicaid eligibility, move into a nursing home, or move out of your Medicare plan's service area, you may be eligible for a Special Election Period to make changes to your prescription drug coverage.
Comparing Medicare Part D coverage in Montana
As mentioned, Original Medicare does not cover prescription drugs, except in certain circumstances. In general, Original Medicare covers prescription medications you get as part of a covered inpatient stay under Medicare Part A or in a doctor's office under Medicare Part B. The medications that Part B covers are typically those you can't administer yourself (for example, infusion drugs).
If you want prescription drug benefits outside of these limited situations, you'll need to enroll in a Medicare Prescription Drug Plan to get coverage for medications not covered under Original Medicare; alternatively, as mentioned, you can also enroll in a Medicare Advantage Prescription Drug plan to get all-inclusive coverage. Even if you are not currently taking prescription medications, it's a good idea to sign up for Medicare Part D as soon as you're eligible if you don't have other creditable prescription drug coverage (insurance that is expected to cover, on average, as much as Medicare Part D). If you don't enroll in Medicare Part D when you're first eligible and don't have creditable prescription drug coverage for 63 days in a row or more, you could face a late-enrollment penalty if you enroll in Medicare Part D later.
Depending on your location and even your county of residence, Medicare Part D costs may vary throughout Montana. Additionally, each private insurance company approved by Medicare may differ when it comes to the specific brand-name or generic medications it will cover. To look up whether a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan covers your medications, check the formulary, which is a list of covered prescription drugs. Keep in mind that the formulary may change at any time. You will receive notice from your plan when necessary.
It's important to carefully consider all Medicare Part D coverage options available to you and make a decision based on your current medication needs and your budget. If you'd like to start searching for Medicare Part D coverage in Montana, simply enter your zip code in the plan finder tool on this page, and we will provide you with a customized list of Medicare plan options available in your area. You can even enter the names of your current prescription medications to help narrow your search. Need help more quickly? Contact eHealth today to speak with a licensed insurance agent.