Common questions

I got a letter saying that Medicare will be starting for me. What happens if I don't sign up now?

• If you don't sign up when you're initially eligible, your Part A premium may go up 10 percent. For example, if you wait to sign up for Part A for a year after you were initially eligible, you'll have to pay the increased premium for 2 years (twice as long as the length of time you waited to sign up).
• If you don't sign up when you're initially eligible, your Part B premium may also go up 10 percent for each 12-month period you could have had it but didn't sign up. This increase in your premium can last as long as you have Part B.
• If you don't sign up when you're initially eligible for Part D coverage, you may have to pay a late enrollment penalty for the period you went without coverage.

I need prescription coverage with Medicare. How do I know what plans are right for me or where to sign up?

Medicare Part D is for prescription drug coverage. To get Part D, you must join a Medicare plan that offers prescription drug coverage. There are two ways to get Medicare drug coverage:

• Medicare Part D
• Medicare Advantage Plan (Part C)

To research available plans or to find which part D plan you have:

• Create an account (or check your account) at Medicare.gov
• Call the Senior Linkage Line at 1-800-333-2433
• Call 1-800-MEDICARE

You can enroll when you're initially eligible for Medicare or during annual open enrollment, which usually takes place from mid-October through mid-December. To learn more, find out how to get prescription drug coverage from Social Security.

I need help paying for Medicare. Are there any programs that help pay for Medicare costs?

Yes!

• Learn about programs for people who need help with Medicare costs from the Minnesota Department of Human Services.
• Social Security offers extra help with Medicare prescription drug plan costs, such as the low-income subsidy.
• Medicare savings programs help with premiums and sometimes co-pays, co-insurance and deductibles.

Why is my prescription not covered by my Medicare Part D plan, and what can I do?

Each insurance plan has a list of approved medications, called a formulary. Formularies vary by plan. If your prescription isn't on this list, it won't be covered by your insurance. Also, some drugs are excluded from Part D coverage by law.

If your prescription isn't covered by your insurance, you might:

• Check with your insurance plan to see if they will cover a generic version of the drug.
• Ask your doctor to request an exception from the insurance plan. If other drugs may be dangerous or less effective for you, your doctor can ask for something called a formulary exception. Or, your doctor might ask the insurance plan to cover your prescription at a lower cost. This is called a tiering exception. If your insurance plan doesn't agree to the exception, you can file an appeal.
• If your prescription was covered before you switched plans or before your plan changed its coverage rules, ask your pharmacist to give you a temporary supply of your prescription through your plan's transition refill policy.
• Apply for a prescription assistance program from NeedyMeds.

If I have Medical Assistance, do I need a Medicare prescription drug plan?

Yes. If you have Medicare and Medical Assistance (MA), you need to enroll in a Medicare prescription drug plan.