I have Original Medicare. Do I need Part D too? (2024)

FAQs

Is Medicare Part D really necessary? ›

Is Medicare Part D worth it? Your health can be unpredictable, so while you may not need many, or any prescription drugs now, you may need them in the future. It's better to enroll in Medicare Part D when you enroll in Original Medicare even if you don't currently need prescription drugs.

Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don't include Medicare drug coverage (like Medical Savings Account Plans and some Private Fee-for-Service Plans), you can join a separate Medicare drug plan.

Part D late enrollment penalty

You'll pay an extra 1% for each month (that's 12% a year) if you: Don't join a Medicare drug plan when you first get Medicare. Go 63 days or more without creditable drug coverage.

Travel considerations: Since Original Medicare doesn't depend on a provider network, your Medicare benefits are good nationwide. However, Medicare Advantage coverage is limited to the plan's service area, which means your plan may not cover you while traveling (except for emergency care).

Disadvantages of Medicare Part D Prescription Drug plans include: Need to anticipate your prescription drug needs for the year: Part D plans differ in the types of drugs they cover. Knowing your medical situation can help you select a plan that is right for you and covers the prescription drugs you expect to need.

If you voluntarily enrolled with Part D and you are not considered dual eligible, you may dis-enroll from Medicare Part D. However, you may pay a higher premium, later if you decide to re-enroll with Medicare Part D. b. If you are a dual eligible (Medi-Medi) client, you cannot dis-enroll with Medicare Part D.

Most individuals that dislike a Medicare Advantage plan usually have had a bad experience with in-network providers, plan authorizations for medical care, or having to wait a long time to have an appointment scheduled. Some of these concerns can be attributed to the healthcare provider.

Your first chance to sign up for Medicare Part D is during your Medicare Initial Enrollment Period (IEP) . But there are other opportunities to enroll, too. You may be able to enroll during the Medicare Advantage Open Enrollment Period (OEP) , or the annual enrollment period for Medicare.

By and large, Plan F is the most popular Medicare Supplement plan due to its coverage of more out-of-pocket Medicare costs than any other Medigap plan type.

An enrollee may use the form, “Part D LEP Reconsideration Request Form C2C” to request an appeal of a Late Enrollment Penalty decision. The enrollee must complete the form, sign it, and send it to the Independent Review Entity (IRE) as instructed in the form.

Why was I automatically enrolled in Medicare Part D? ›

You'll be auto enrolled in Medicare Part D prescription drug coverage if: You're part of the government Low-Income Subsidy program because you qualify for Medicare and Medicaid. You're currently receiving Supplemental Security Income.

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

People with Medicare are drawn to Medicare Advantage for the extra benefits. Medicare Advantage plans offer extra benefits, like reduced cost-sharing, dental coverage, gym memberships and debit cards for over-the-counter medical supplies that are not covered by traditional Medicare.

Medicare doesn't typically cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket costs including copayments, coinsurance, and deductibles. As you'll learn in this article, Original Medicare (Part A and Part B) costs can really add up.

In 2003, Congress signed into law the Medicare Prescription Drug, Improvement and Modernization Act. This law includes a prescription drug benefit called Medicare Part D. This new law makes prescription drug coverage available to all Medicare beneficiaries beginning January 1, 2006.

In 2024, once your out-of-pocket spending reaches $8,000 (including certain payments made on your behalf, like through the Extra Help program), you'll automatically get “catastrophic coverage.” This means you'll pay nothing for your covered Part D drugs for the rest of the calendar year.

Out-of-pocket costs

Health or prescription drug costs that you must pay on your own because they aren't covered by Medicare or other insurance. will be capped at $2,000, starting in 2025.

According to the U.S. Bureau of Labor Statistics, about 1 in 10 Americans over age 65 will still be working in 2030. If you're about to turn 65 and you're still in the workforce, you may wonder if you can have both employer-sponsored insurance and Medicare. The answer is yes, but there are a few points to consider.