SHIBA Frequently Asked Questions

When can I switch Medicare drug plans?
Generally, you can switch to a new plan November 15 through December 31 of each year and the new coverage will start January 1 of the following year. Once you enroll in a Medicare drug plan, you are generally enrolled for a calendar year.

Is it important to look at the Medicare drug plans every year?
Yes, especially if you are not happy with your current plan. Plans may come and go from year to year and you may be able to find a plan that better suites your needs.

What if I can’t afford to pay the costs to join a Medicare prescription drug plan?
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.socialsecurity.gov on the web or call Social Security at 1-800-772-1213.

What is the difference between a PDP and an MAPD?
PDP means "Prescription Drug Plan," a separate plan for prescription drug coverage only.  It is not a medical insurance plan so it does not cover doctor visits, hospital care or any other medical services.

MAPD means "Medicare Advantage plan with prescription drug coverage."  This is a Medicare-approved plan you buy from a private insurer that includes benefits for medical services and prescription drugs.  It is health insurance and prescription drug coverage, and maybe a few extra benefits and services, all in one plan.

A woman I know is under 65, but has Medicare. Is that possible?
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

I can’t afford my Medicare premiums or out-of-pocket costs. What can I do?
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 & Welfare office to determine if you qualify.

What if I’m in a Medicare Savings Program and I move out-of-state?
While Medicare is a federal program, Medicare Savings Programs are administered by local Medicaid offices, which operate differently from state to state. If you move to a new state, your Medicare Savings Program does not move with you. Instead, you must apply for a Medicare Savings Program in the new location. Income and asset limits, as well as how income is calculated, can vary by state.