Medicare

FAQ

• What are the benefits of Medicare Part D?

  If you've been paying cash for your prescriptions, Medicare Part D may save you money. Each provider's plan must be approved by Medicare, which means you have the security of reliable prescription insurance, no matter which plan you choose.

• Who is eligible for Medicare Part D prescription drug coverage?

  All individuals with Medicare Part A or Medicare Part B are eligible to enroll regardless of age, income or health conditions.

• Which drugs are excluded from Medicare Part D plans?

  Medicare requires Part D plans to exclude the following medications: Prescription drugs used for anorexia, weight loss, or weight gain; prescription drugs used to promote fertility; prescription drugs used for cosmetic purposes or hair growth; prescription drugs used for the symptomatic relief of cough and colds; prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations; non-prescription drugs; inpatient drugs; barbiturates (sleeping pills); and benzodiazepines (central nervous system depressants).

• Will Medicare Part D cover prescription drugs purchased from Canada?

  No. Only prescription drugs sold in the United States are eligible for Part D coverage.

• Can I change Medicare Part D prescription drug plans once I have enrolled?

  Yes, you can change your Medicare Part D prescription drug plan. The opportunities to switch are:

  Annual enrollment: Each year, you will be able to choose a different Medicare Part D prescription drug plan or Medicare Advantage plan during an annual enrollment period. The enrollment period is October 15 through December 7. Coverage under the new plan will begin the following January 1.

  Other exceptions: There are other limited exceptions that may give you the right to switch plans during a year. For example, if you move out of the service area of your current plan, you will have an opportunity to choose another plan that serves your new area.

• If I live in the U.S. territories, will I have access to a Medicare Part D prescription drug plan?

  Yes, Medicare Part D plans will be available in the U.S. territories.

• Will Part D coverage only be available through a private company, or will I be able to get coverage directly from Medicare, the same way that I get Part A and Part B coverage?

  No, Part D coverage will not be available directly from Medicare. Although you will be able to have your premium deducted from your Social Security check, you must purchase Part D coverage from a private company that has been approved by Medicare to offer coverage.

• How will I know if the prescription drugs I currently take will be covered?

  Each Medicare Part D prescription drug plan is required to cover the drugs mandated by Medicare. Each Medicare Part D prescription drug plan will provide its own formulary or list of covered drugs. This information will be available through the plan's web site, customer service center and through marketing materials. You can also find information online at Medicare.govopens a simulated dialog or by calling 800-633-4227 (TTY users: 1- 877-486-2048) 24 hours a day, seven days a week.

• Who decides which prescription drugs will be covered on a formulary?

  Although the list of covered prescription drugs may vary by Medicare Part D prescription drug plan, all Medicare Part D prescription drug plans must meet formulary requirements set by Medicare. The formulary will include both generic and brand name prescription drugs. Each plan must use a Pharmacy and Therapeutic Committee, which includes doctors and pharmacists, to establish its formulary. This process assures you access to a number of prescription drugs, although not necessarily all prescription drugs.

• I have drug coverage through the Veterans' Administration (VA). Can I continue to get my prescriptions through the VA?

  Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their prescriptions through the VA.

• I take several different prescription drugs. Will there be help with managing all my medications?

  Yes, one of the advantages of Medicare Part D prescription drug plans is that there will be help managing prescription drugs for people who take multiple medications, have chronic diseases, such as diabetes or heart disease, and high drug costs. The help is designed to make sure that your medications work well together and reduces the risk of a bad reaction. You might also hear this called medication therapy management.

• What if I cannot afford insurance?

  If you're worried you will not be able to afford a Medicare Part D prescription drug plan, you may qualify for extra help. Contact your local Social Security Administration office for details, visit the agency online at https://www.ssa.gov/benefits/medicare/prescriptionhelp/opens a simulated dialog or call 800-772-1213. You may also qualify for other drug discount programs. Talk to your Walgreens pharmacist for more information.

• Is enrollment voluntary?

  Yes. However, the longer you wait to sign up, the higher your premium will be. If you don't sign up for a Medicare Part D prescription drug plan when you are first eligible, you will pay a 1% penalty per month – up to a 12% penalty for each year – you wait before signing up. So if you think you might need Medicare Part D later, you could save by signing up now. (If you are currently covered by a prescription drug plan through your employer, this may not apply to you.)

• What if I want to switch plans after enrolling?

  No problem. Every year there will be an Annual Enrollment Period. Annual Enrollment Period is October 15 through December 7. You may change Medicare Part D prescription drug plans at that time.

• Where can I get my prescriptions filled?

  At any pharmacy within your network. Most Medicare Part D prescription drug plans will charge the same copay, as long as you go to a network pharmacy. Each network will have several pharmacy options, so you can go to a pharmacy that offers the services and convenience that best meet your healthcare needs. You'll get all of that at Walgreens.

• Why is there a late enrollment penalty?

  Congress believes that unless you already have creditable prescription drug coverage, Medicare Part D prescription drug plans are a great way to help you with the cost of prescription drugs. They crafted the rules to encourage people to enroll in the beginning instead of waiting to join only when health problems develop and drug costs rise. The late enrollment fee gives people a reason not to postpone the decision to join.

• How do I know if I should sign up?

  You will need to review your options carefully to see if a Medicare Part D prescription drug plan is right for you. Part D plans may provide financial savings to most people with Medicare. As insurance plans, they provide protection against future, unexpected costs. They also provide additional financial assistance for qualifying people with lower incomes.

• How do I find out if I qualify for help?

  Contact your local Social Security Administration office for details, visit the agency online at https://www.ssa.gov/benefits/medicare/prescriptionhelp/opens a simulated dialog or call 800-772-1213. You may also qualify for other drug discount programs. Talk to your Walgreens pharmacist for more information.

• What assets will be counted to determine if I am eligible for help?

  The assets that will be counted include cash or any property that can be converted to cash within 20 days. This includes checking accounts, savings accounts, certificates of deposit, retirement accounts (like IRAs or 401ks), stocks, bonds, mutual fund shares, promissory notes and mortgages. Property that is not counted includes your life insurance policies, primary home, burial plots or burial agreements. Certain funds set aside for burial expenses, up to $1,500, will also not be counted.

• Can premiums be deducted from Social Security checks?

  Yes, you will have the option to have the premium deducted from your Social Security check (just like your Medicare Part B premium).You must continue to pay your Part B premium. If applicable, you or your former employer can pay your premium directly to the private company.

• What is creditable coverage?

  Creditable coverage is coverage from a plan other than a Medicare Part D prescription drug plan that meets certain Medicare standards. If you currently have prescription drug coverage that is considered creditable coverage, you may keep that coverage and wait to enroll in a Medicare Part D prescription drug plan. If you later decide to enroll in a Medicare Part D prescription drug plan, you will not have to pay a late enrollment penalty.

• Which plan should I pick?

  Based on your specific prescription drugs, Walgreens can help you navigate Medicare enrollment with education, answer questions and provide cost information about different Medicare Part D and Medicare Advantage options in your area. It's important to review medical, financial, and other important considerations when selecting a plan. We can't make specific plan recommendations, but you can visit Medicare.gov;opens a simulated dialog call 800-633-4227 (TTY users: 1-877-486-2048) 24 hours a day, seven days a week; or talk to a licensed insurance agent or insurance company to determine which plan is best for you.

• Do I need to re-enroll in a plan if I am already enrolled in Medicare?

  If you're already on a Medicare Advantage or Medicare Part D plan eligible for renewal, most plans renew your enrollment automatically. Contact your plan insurance company or a licensed insurance agent to confirm this is the case. Your insurance company will send you an ANOC (Annual Notice of Change) which outlines all the changes to your plan for the next year, including whether your plan is discontinued or has changed substantially enough for you to consider shopping for new plan options. Visit Medicare.gov;opens a simulated dialog call 800-633-4227 (TTY users: 1-877-486-2048) 24 hours a day, seven days a week; or talk to a licensed insurance agent or insurance company for more information.

• Do I need to enroll in a plan if I am eligible but not currently enrolled in Medicare?

  If you're eligible but do not enroll in a Medicare Advantage or Medicare Part D plan during the Annual Enrollment Period, you may not be able to apply for or receive Medicare coverage for the upcoming year. To determine if you are eligible for special circumstances, visit Medicare.gov;opens a simulated dialog call 800-633-4227 (TTY users: 1-877-486-2048) 24 hours a day, seven days a week; or talk to a licensed insurance agent or insurance company for more information.

• Why do copays vary across the different "tiers"?

  Prescription drugs are grouped into different tiers by each carrier and plan. The tiers may be based on whether a prescription drug is generic or branded and other factors. Your local Walgreens pharmacist can work with you to see if there are prescription drug alternatives that may lower your copay.

• What is included in the "Estimated Annual Costs"?

  The "Estimated Annual Costs" value represents an estimated total out-of-pocket cost you would pay for that specific plan. The value is calculated by adding the annual deductible, the monthly premium (multiplied by 12 months), and the total estimated drug-specific copay or co-insurance costs (based on your current medications covered by the plan).