Q: Why does my plan require prior authorization for some drugs?
A: Prior authorization ensures that certain medications are medically necessary or used correctly. Your doctor will submit documentation to approve the prescription.
Q: Can I use GoodRx with Medicare Part D?
A: Yes, but not together. You can choose to use a GoodRx discount instead of your Part D plan for a specific prescription, but that purchase won’t count toward your plan’s out-of-pocket total.
Q: What is a drug formulary?
A: It’s your plan’s official list of covered drugs. Formularies are organized into tiers, and each tier has different copay amounts.
Q: Why do my prescription costs change during the year?
A: Part D has four phases: deductible, initial coverage, donut hole, and catastrophic coverage. As your yearly drug spending increases, you move through these phases and your costs adjust.
Q: Do I need Part D if I don’t take any medications?
A: Yes, most people should still enroll. If you don’t, you’ll pay a lifetime penalty when you eventually need drug coverage—plus you won’t be protected if a new medication becomes necessary.
Q: Do I need Medicare if I’m covered under my spouse’s employer plan?
A: You may be able to delay Part B penalty-free if the employer has 20+ employees. If the employer is smaller, Medicare may still need to be primary.
Q: What if I missed my Initial Enrollment Period?
A: You can sign up during the General Enrollment Period (Jan 1–Mar 31), but your coverage will start later and you may face a Part B late penalty.
Q: Do I need Medicare if I’m still working?
A: If your employer has 20 or more employees, you may delay Part B without penalty. If the employer has fewer than 20, you usually need Medicare because it becomes your primary insurance.
Q: What’s the difference between Medicare and Medicaid?
A: Medicare is federal insurance mainly for people 65+ or with certain disabilities. Medicaid is a state-run program that helps people with very low income. Some people qualify for both, which lowers their out-of-pocket costs significantly.
When should I enroll in Medicare if I’m turning 65?
A: Your enrollment window opens 3 months before your 65th birthday, includes your birthday month, and closes 3 months after. Enrolling early ensures your coverage starts on time.