Coverage for Prescription Drugs
Individuals who have Medicare Part A and/or Part B may enroll in a Part D plan.
Medicare Part D plans are offered by private insurance companies and must be approved by Medicare.
Plans vary in premium and coverage (covered drugs, copayments and deductibles, preferred pharmacies and mail order options).
Not enrolling in a Medicare Part D plan, when you are eligible, may result in a late enrollment penalty.
You do not need to enroll in a Part D plan if you have “creditable” drug coverage through an employer policy, VA benefits or TriCare for Life.
You should evaluate your Medicare Part D plan every year between October 15 and December 7. Most people find they can save money if they switch to a different plans. Your new plan will begin January 1 of the next year.
How to Select a Medicare Prescription Drug Plan
Contact SHIP at 301-255-4250 for help in evaluating your options. Complete this Medicare Part D Prescription Drug Worksheet and mail it to the SHIP office. We will evaluate your options and send you a Medicare prescription drug plan recommendation.
For a guide to how to enter your drugs and shop for a Medicare Part D Plan, click here Self Help Guide for PDP or go directly to Medicare’s plan finder tool to evaluate the best policy on your own at: https://www.medicare.gov/find-a-plan/questions/home.aspx
Ways to Save Money with Your Part D Prescription Drug Plan.
Currently there are two Programs available to reduce your Part D prescription drug costs. These are the Low Income Subsidy (LIS) and Maryland’s Senior Prescription Drug Assistance Program (SPDAP). Each is detailed below.
Low Income Subsidy (LIS) or “Extra Help”
The Federal Government’s Low Income Subsidy (LIS), also called “Extra Help,” is a program administered by Social Security. If you qualify, you get help paying for your Medicare Part D plan’s monthly premium, deductible, and for some of the costs of your prescriptions. You also have the option to change your Rx Part D plan every month.
To be eligible for LIS, income must be at or below $18,330 a year ($1,528 monthly) for a single person; $24,600 a year ($2,050 monthly) for a couple. Income can be higher if you are working and a portion of your income is from earned wages.
There is also an asset test of $13,820 or less for a single person and $27,600 or less for a couple. Assets include savings, stocks, bonds, IRAs but not your home or car.
How to Apply for LIS
LIS applications can be completed on-line at LIS Application page or are available by mail from the SHIP office at 301-255-4250. You can also apply directly through Social Security Office at 1-800-772-1213.
Maryland Senior Prescription Drug Assistance Program (SPDAP)
The State of Maryland program that provides eligible Medicare beneficiaries with help paying their premiums and/or cost sharing for Medicare Part D prescription drug Plans. If you are eligible for SPDAP, you may have one more time during the year to change your Medicare Part D Drug Plan.
You may be eligible if your income is at or below $36,180 ($3,015 monthly) for a single person or $48,720 ($4,060 monthly) for a couple – with NO regard to your assets.
SPDAP will pay (up to) $40 each month toward the premium in any Part D Drug Plan or Medicare Advantage Plan in Maryland.
A limited number of SPDAP participating plans provide an extra donut hole subsidy. You must be enrolled in one of those plans in order to get help in the coverage gap.
How to Apply for SPDAP
To apply for SPDAP, call SPDAP at 1-800-551-5995 or go to www.marylandspdap.com. Applications are available from SHIP at 301-255-4250 or download the SPDAP application here: Maryland SPDAP Application.
Medicare Part D Premium Adjustment
In addition to the Part D plan premium, deductible and copayments, those with incomes above $85,000 (individuals) and $170,000 (joint) pay an income-related premium adjustment.
If your Yearly Income is:
You Pay This Amount
|Individual Tax||Joint Tax|
|$85,000 or less||$170,000 or less||$0 + plan premium|
|$85,0001 – $107,000||$170,001 – $214,000||$13.30 + plan premium|
|$107,001-$160,000||$214,001-$320,000||$34.20 + plan premium|
|$160,001-$214,000||$320,001-$428,000||$55.20 + plan premium|
|Above $214,000||Above $428,000||$76.20 + plan premium|