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Frequently Asked Questions
Here are some of the most frequently asked questions about Medicare Part D and drug formularies. If your question is not included, please send us an email and we will get back to you as quickly as possible.
Medicare Part D FAQ
1. Who can get Medicare Part D prescription drug coverage?
2. Do I have to enroll in Part D?
3. Can I get Medicare Part D prescription drug coverage if I don’t have a Medicare supplement or Medicare Advantage plan?
4. If I am turning 65 and want Medicare Part D drug benefits, can I join a Prescription Drug Plan or Medicare Advantage plan only at certain times of the year?
5. I’m currently enrolled in a Medicare supplement plan with prescription drug coverage. Do I have to change plans if I want to keep my prescription drug coverage?
6. If I am currently enrolled in a Medicare supplement plan that includes prescription drug coverage and want to enroll in a Medicare Part D plan, can I?
Drug Formulary FAQ
7. What is the formulary?
8. How will my doctor know to prescribe a medication on the formulary?
9. What is the mail-order program?
top of page1. Who can get Medicare Part D prescription drug coverage?
All Medicare beneficiaries are eligible to enroll. You must be entitled to Medicare Part A or enrolled in Medicare Part B. You must also live in the service area of the plan you join. Our service area includes Bucks,
2. Do I have to enroll in Part D?
No. Enrollment in Medicare Part D is voluntary. However if you don’t enroll in a Part D plan as soon as you’re eligible, you may pay a penalty if you enroll later.
3. Can I get Medicare Part D prescription drug coverage if I don’t have a Medicare supplement or Medicare Advantage plan?
Yes. If you are enrolled in Original Medicare, you can continue with it and choose your Part D coverage from a private plan that provides coverage only for prescription drugs.
4. If I am turning 65 and want Medicare Part D drug benefits, can I join a Prescription Drug Plan or Medicare Advantage plan only at certain times of the year?
No. If you are turning 65, you may enroll in a Medicare Prescription Drug Plan or Medicare Advantage plan during your Initial Coverage Election Period for Medicare Part B. This period includes the three months prior to your birth month, your birth month, and the three months after your birth month.
5. I’m currently enrolled in a Medicare supplement plan with prescription drug coverage. Do I have to change plans if I want to keep my prescription drug coverage?
No. As long as you are enrolled in a Medicare supplement plan that provides prescription drugs prior to January 1, 2006, you can remain in this Medicare supplement plan. However, if you decide to enroll in a Medicare Part D drug plan later, you may pay a penalty for late enrollment.
6. If I am currently enrolled in a Medicare supplement plan that includes prescription drug coverage and want to enroll in a Medicare Part D plan, can I?
Yes. You can move to a medical-only Medicare supplement plan and join a standalone Part D drug plan.
7. What is the formulary?
A formulary is a defined list of medications that have been selected for their medical effectiveness, positive results, and value. When you have your prescription filled at a participating network pharmacy, you will have lower out-of-pocket costs when you use a drug on the formulary. If a drug is not on the formulary, your out-of-pocket costs will be higher. A mail-order pharmacy is also available.
8. How will my doctor know to prescribe a medication on the formulary?
Have your doctor review the Drug Formulary Pocket Guide to determine if your prescription medications are on the formulary. You might already be taking formulary medications. If you are, you will pay only your cost-share for these drugs. If you are prescribed covered drugs that are not on the formulary, ask your doctor to review your Drug Formulary Pocket Guide to see if another drug on the formulary, such as a generic equivalent or therapeutic alternative, can be used to treat your condition. If, after discussion with your doctor, he/she does not prescribe a formulary medication, your covered prescription will be subject to the higher cost-share.
9. What is the mail-order program?
The voluntary mail-order program saves you copays and allows you to get medications delivered directly to your home. When you are prescribed a maintenance drug, ask your doctor to write you two prescriptions — one for a 30-day supply to be filled immediately at a local, participating pharmacy and one for a 90-day supply (plus any necessary refills) to be filled through mail-order. Once you are enrolled, you will receive a mail-order envelope in your Welcome Kit. You may obtain additional mail-order envelopes by calling the number on the back of your identification card.