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SHIBA Frequently Asked Questions

What if I can’t afford to pay the costs to join a Medicare prescription drug plan (PDP) or Medicare Advantage prescription drug plan (MAPD)?
If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs. Almost 1 in 3 people with Medicare qualify for extra help that will cover between 85% and almost 100% of their prescription drug costs. To find out whether you qualify or not visit www.ssa.gov on the web or call Social Security at 1-800-772-1213.

I am new to Medicare and enrolling in a drug plan for the first time, but there are so many choices. How do I find the right Part D plan?

There are two types of Part D drug plans to choose from - PDP or MAPD. Which one you should sign up for depends on how you get your Medicare health benefits:

  • Medicare or Medigap: If you want to get your health coverage through Original Medicare or Medigap insurance, choose a stand-alone Prescription Drug Plan (PDP) that only covers drugs.
  • Medicare Advantage: Medicare Advantage plans are Medicare private health plans sold by insurance companies. If you want a Medicare Advantage plan and Part D, you must generally get your drug coverage as part of your Medicare Advantage plan's benefit package. Most Medicare Advantage plans come with  Part D, but not all do. There are certain types of Medicare Advantage plans (such as Private Fee-for-Service plans) that will allow you to enroll in a separate stand-alone PDP if they do not cover prescriptions.
  • Make a list of the medicines you take. Also write down the pharmacy you use regularly. Then go to Medicare.gov and use the Plan Finder tool to search for plans that cover your drugs at the pharmacies you use. The Plan Finder tool will generate a list of Part D plans in your area that cover your drugs and have your pharmacies in their networks. You can also call (800) MEDICARE to do this search over the phone. A plan may have a low premium but other plans may have lower copays or deductibles, cover more of your drugs or have fewer coverage restrictions.

    Remember to choose carefully. You can usually only change your Medicare health and drug coverage at certain times of the year.

Is a person under 65 eligible for Medicare?
Yes. You can have Medicare if you are under 65 if: 1) you are disabled and have been receiving Social Security Disability Insurance for more than 24 months; OR 2) you get continuing dialysis for permanent kidney failure, or you have had a kidney transplant (End-Stage Renal Disease - ESRD); OR 3) you have been diagnosed with Amytrophic Lateral Sclerosis (ALS), commonly know as Lou Gehrig's Disease

What can I do if I cannot afford my Medicare premiums or out-of-pocket costs?
If your income is limited, the State may help pay your Medicare costs, such as your premiums and deductibles. There are Medicaid and the Medicare Savings Programs, QMB (Qualified Medicare Beneficiary), SLMB (Specified Low Income Medicare Beneficiary) that could assist you, depending upon your income and assets. Contact your local Health and Welfare office to determine if you qualify.

How are vaccines covered under Medicare?

  • Flu vaccine: covered by Part B with no copayment or deductible.
  • Hepatitis B vaccine: covered by Part B for people who are considered medium or high risk such as hemophiliacs or people with end stage renal disease. For low risk people it is covered under Part D.
  • Pneumonia vaccine: covered once in a lifetime by Part B for everyone who is low risk. High risk people including people with leukemia or other immunosuppresive diseases are covered once every five years.
  • Tetanus vaccine: covered by Part B with likely co-payment.
  • Shingles vaccine: is covered by Part D.

It is important for people with Medicare to contact their Medicare Advantage or Part D plan to find out their rules about how vaccines are covered at the doctor’s office versus pharmacy.