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Medicare Prescription Drug Coverage

A Medicare Prescription Drug Plan (PDP) can help lower your current drug costs and protect you against higher costs in the future. Prescription drug plans are only available from private insurance companies, such as Horizon Blue Cross Blue Shield of New Jersey.

How does a PDP plan work?

A Medicare Prescription Drug Plan (PDP) works like other insurance plans. Typically, you pay a predictable portion of your prescription drug costs — in other words, a deductible, copayments or coinsurance — and the plan pays the rest.

Who is eligible for Part D coverage?

Medicare prescription drug coverage (Part D) is available to everyone with Medicare. You must decide whether or not to receive Medicare prescription drug benefits when you first become eligible for Medicare.

If you decide NOT to join a Medicare drug plan during your Initial Enrollment Period and you don’t receive Extra Help for your Medicare or you don’t have other creditable prescription drug coverage (benefits that are considered equal to or better than Medicare Part D benefits), you may have to pay a late enrollment penalty.

When and how do you enroll?

From October 15 and December 7, anyone can join, switch or drop a Medicare Prescription Drug Plan. Your coverage will begin January 1 of the following year. If you go 63 days or more in a row without a Medicare drug plan or other creditable coverage, you may have to pay a late enrollment penalty.

Elegible para Medicare?

Si usted es elegible para Medicare, podrá inscribirse en un plan de Medicamentos de Receta Medicare de Horizon Blue Cross Blue Shield of New Jersey durante los períodos específicos del año conocidos como períodos de inscripción o períodos de elección. Los materiales de inscripción están disponibles en español si se necesitan.

Para más información acerca de la inscripción, comuníquese con Servicio a Clientes de Horizon Blue Cross Blue Shield of New Jersey. al 1-877-234-1240 (usuarios de TTY/TDD: 1-800-852-7899) de lunes a viernes entre las 8 a.m. y las 8 p.m., hora del Este.

Si ya está inscrito en un Plan Horizon Medicare Advantage con Horizon Healthcare of New Jersey, Inc., y su pregunta se relaciona con su Evidencia de Cobertura, haga clic aquí.

Frequently Asked Questions

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Medicare provides limited prescription coverage. That’s why many people choose to obtain additional coverage, to help offset their prescription drug costs.

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Yes, Medicare Prescription Drug Plans cover both brand name and generic drugs from a formulary (a list of approved medications).

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If you get a stand-alone PDP to add to Original Medicare or Original Medicare plus a Medicare Supplement plan, you will receive a separate card to use when you fill your prescriptions. If you enroll in a Medicare Advantage plan that includes prescription drug coverage, you will have one card for all your coverage.

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Most PDPs charge a monthly fee that varies by plan. You pay this in addition to the Part B premium. If you belong to a Medicare Advantage plan that includes Medicare prescription drug coverage, the monthly premium will include the prescription drug coverage.

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You may qualify for additional help. Several programs are available to assist you with covering additional costs. Also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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To be eligible, you must be entitled to Medicare benefits under Part A and/or enrolled in Part B and live in New Jersey. You can only be enrolled in one Medicare-approved Part D prescription drug plan.

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No. You will not have to answer any health questions to enroll in this plan.

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No. That is why it’s important to compare plans carefully. Ninety-eight percent of New Jersey's pharmacies participate in Horizon Blue Cross Blue Shield of New Jersey's network.

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No. Compare each plan carefully. Obviously, the more drugs that are covered, the more likely you are to find the ones you need.

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Yes, you may switch your current health insurance plan from your previous employer to Horizon's Prescription Drug Plan. However, if your current drug coverage is of equal or greater value than the standard Medicare-approved prescription drug coverage, you may want to keep your current coverage and wait to enroll in a Medicare–approved Prescription Drug Plan. (The organization offering your current coverage, such as your former employer, union or the insurance company they have hired, is required to tell you whether your current coverage is comparable.) If you later decide to join a Medicare Prescription Drug Plan, you will not be subject to the late enrollment penalty if your previous coverage was considered comparable. Your Medicare prescription drug plan may require information about your old coverage.

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Yes. PAAD is a pharmaceutical assistance program and does not actually function as prescription coverage.

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No. However, if you choose to purchase a prescription drug plan after your initial Medicare enrollment period expires (three months after you reach age 65) you will be charged with a late enrollment penalty. This penalty is not assessed by Horizon BCBSNJ. This penalty is assessed and regulated by CMS.

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No. Enrolling in a Medicare Advantage plan will automatically end your enrollment in another Medicare health plan or prescription drug plan.

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