If you are new to Medicare, there are several questions you should consider while approaching or within your Initial Enrollment Period (IEP) or a Special Enrollment Period (SEP). Use this guide to consider your options when preparing to enroll in Medicare or after you have already enrolled. What are the
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Medicare cards
Everyone who enrolls in Medicare receives a red, white, and blue Medicare card. This card lists your name and the dates that your Original Medicare hospital insurance (Part A) and medical insurance (Part B) began. It will also show your Medicare claim number, which serves as an identification number in
Prescription drug coverage (Parts A, B, and D)
While Medicare Part D covers your prescription drugs in most cases, there are circumstances where your drugs are covered under either Part A or Part B. Part A covers the drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility (SNF). Note: If you are getting
Part D-covered vaccinations
If your provider recommends that you get a vaccine, in most cases it will be covered by your Part D plan. Part D plans must include most commercially available vaccines on their formularies, including the vaccine for shingles (herpes zoster). The only exceptions are flu, pneumonia, and hepatitis B vaccinations,
Introduction to Part D appeals
If you were denied coverage for a prescription drug, you should ask your plan to reconsider its decision by filing an appeal. The appeal process is the same in stand-alone Part D plans and Medicare Advantage Plans with Part D coverage. Follow the steps below if your plan denied coverage
Creditable drug coverage
Creditable drug coverage is, on average, as good as or better than the basic Part D benefit. You should receive a notice from your employer or plan around September of each year, informing you if your drug coverage is creditable. If you have not received this notice, contact your human
Medicare Savings Program basics
Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited income and savings. There are three main programs, each with different benefits and eligibility requirements.* Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B
Part D late enrollment penalties
For each month you delay enrollment in Medicare Part D, you will have to pay a 1% Part D late enrollment penalty (LEP), unless you: Have creditable drug coverage Qualify for the Extra Help program Prove that you received inadequate information about whether your drug coverage was creditable In most
Part D costs for those with higher incomes
The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an amount you may have to pay in addition to your Part B or Part D premium if your income is above a certain level. The Social Security Administration (SSA) sets four income brackets that determine your (or your and your spouse’s)
Competitive bidding
The durable medical equipment (DME) competitive bidding program is designed to reduce your out-of-pocket expenses and help ensure that you have access to quality DME, supplies, and services from suppliers you can trust. The program affects you if: You have Original Medicare Live in a competitive bidding area Most states