Medicare: Medicare Part C Advantage Plans and Part D Plans

What is a Medicare Advantage Prescription Drug Plan (MA-PD)?

Combining the benefits of Medicare Part A (hospitalization), Part B (outpatient medical care), and Part D (prescriptions) into one plan, Medicare Advantage Prescription Drug Plans (Medicare Part C Plans or MA-PDs) are offered through private insurance companies. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a MA-PD, Medicare services are covered through the plan instead of Original Medicare. You can generally get some additional medical coverage through MA-PDs compared to original Medicare A & B, but you will likely be limited to a network of providers.  Please note that MA-PDs vary considerably in the different counties of Washington State. 

Medicare Supplement (Medigap) Plans also are available that offer medical coverage to go with your Medicare Part B. They do not offer prescription coverage and Evergreen cannot pay for them, however, so they are not covered further here. You can find more information about these plans on the Medicare website.

If you are a current EIP client, Evergreen can pay for your MA-PD if the premium is between $60 — $250 monthly. If your premium is less than $60 because you have Low Income Subsidy/Extra Help (LIS/EH), Evergreen may still be able to pay this premium.

What is Medicare Part D?

Part D is the prescription drug-only coverage portion of Medicare. Part D prescription drug coverage is available through private insurance companies that offer Medicare-approved prescription drug plans (PDP).  In contrast to MA-PDs, however, PDP benefits are uniform throughout Washington State.  There are many different Medicare Prescription Drug Plans to choose from and each plan may have a premium. Evergreen can assist you in choosing the plan that is best for you and in paying your premium.

Medicare Part D has tiers of prescription coverage that are different from most other types of insurance coverage. There are times of the year when you may be responsible for significant prescription costs, even though you have prescription coverage. When you are an EIP client, EIP can help you with some of these costs. The Low-Income Subsidy or Extra Help (LIS/EH) from the federal Social Security Administration can also help you with these costs.

Am I eligible for Medicare Part D?

Anyone who has Medicare, or becomes eligible for it, is entitled to prescription drug coverage through Part D.

  • If you have Medicare Part A or Part B, you are eligible for a PDP. PDPs are statewide plans.
  • If you have Medicare Parts A and B, you are eligible for both PDPs and MA-PDs.  Again, please note that MA-PDs are not state-wide plans and their benefits can vary among counties in Washington State. 

If you have Medicare and Medicaid, you also have medical coverage through Medicaid. Therefore, you probably do not need the extra medical coverage of an MA-PD.

People with Medicare and Medicaid and other low-income populations can qualify for Extra Help. If your income is below 150% Federal Poverty Level, EIP does require that you apply for Extra Help. This can help reduce your prescription costs.

Can Evergreen pay for my Medicare Part D or MA-PD premiums?

Yes, Evergreen can pay for PDPs, as well as MA-PDs that have prescription drug coverage as long as the MA-PD monthly premium is between $60 and $250 (some exceptions apply).

  • If you have Medicare and Medicaid, you may not be responsible for a PDP premium. You can choose to enroll in a PDP plan with richer benefits that does have a premium for you to pay. Evergreen can help you with this premium.

How do I apply for a MA-PD or PDP?

You can go online to www.medicare.gov to see the list of plans available in your area. If you want Evergreen to pay your premium, then only consider MA-PDs or PDPs. You should choose a plan that offers the best coverage based on prescriptions you currently take and anticipate taking in the future. An insurance advocate at Evergreen or your case manager can help you review your options and choose the best plan for you.

Here are some resources to help you choose the best Medicare Drug Plan for your needs:

  • An overview of Part D to help you understand and compare the key benefits and costs of Part D plans.
  • A video overview of the Prescription Drug Plan Finder. The video requires a high-speed Internet connection.
  • A video training to help you understand how to use the online Drug Plan Finder. The training requires a high-speed Internet connection.

After selecting the best Medicare Drug Plan for you:

  • If you selected a plan using the online Medicare Plan Finder, you may also be able to complete an application online. (Not all plans listed in the Plan Finder offer this convenience.)  Print out and save a copy of the resulting confirmation notice that appears on your computer. You can also submit a paper application, but the online application is much faster. If you submit a paper application, be sure to retain a copy.
  • If you are not yet enrolled in EIP, download and print the dual application for EIP and the Evergreen Health Insurance Program (PDF) and submit it directly to EIP only.  (If you want Evergreen's assistance with medical insurance premiums, be sure to complete Section 3.)  If you are currently enrolled in the EIP program, download and print the Evergreen New Enrollment/New Payable application and then fax or mail it to Evergreen only
  • We will process your application and send a check to your Part D plan once we receive a bill from the Part D plan. This bill may go directly to you; please be sure to mail it to Evergreen if it does.

Other important information about MA-PDs and PDPs

There are specific limited enrollment periods:

  • When you first become eligible for Medicare due to turning 65, you can enroll in a PDP or MA-PD three months before the month of your 65th birthday, or up to three months after, for a total of seven months.
  • If you become eligible for Medicare due to a disability, you can enroll three months before to three months after your 25th month of receiving cash disability payments.

Please note that not enrolling in a Medicare Part D PDP or MA-PD may result in penalties. However, if you currently have insurance coverage that is as good as the coverage offered by a Medicare Drug Plan, you may be able to keep that policy without enrolling in a Medicare Drug Plan. Please contact your case manager or the Evergreen Health Insurance Program for more information.

If you did not enroll in a PDP or MA-PD when you became eligible, note that open enrollment will be held between October 15 and December 7 of each year.

  • If you are enrolled in a MA-PD, between January 1st and February 14th you can dis-enroll and switch over to Original Medicare.  You may also opt for a PDP during this time.  However, you may not switch to a different MA-PD.
  • People with both Medicare and Medicaid, or people with Extra Help, can change their Part D plan once a month.

The benefits and formularies of Part D plans can change from year to year. Please review the information from your Part D plan every fall. Make sure your plan will still work for you in the coming year.

For more detailed information please visit the Medicare website.