New Hampshire Medicare Part D FAQ

Some common questions about Medicare Part D include:

1) What is Medicare Part D and what does it cover for New Hampshire Medicare beneficiaries?

Medicare Part D is an optional benefit that provides coverage for prescription drugs. It is available to people who are enrolled in Medicare Part A and/or Part B in New Hampshire. Medicare Part D plans are offered by private insurance companies that are approved by Medicare.

Medicare Part D plans vary in terms of which drugs they cover and the cost of the coverage. Most plans have a list of drugs that they cover, called a "formulary," and may place certain drugs on a tier with a different level of cost-sharing. Some plans may also offer additional coverage for certain drugs or classes of drugs that are not covered by Medicare, such as drugs for rare conditions or diseases.

In general, Medicare Part D plans cover a wide range of prescription drugs, including medications for conditions such as high blood pressure, diabetes, and high cholesterol. However, they do not cover drugs that are not considered medically necessary, such as over-the-counter drugs or drugs for cosmetic purposes. It's important to check with your Medicare Part D plan to see which drugs are covered and at what cost.

"Most Part D plans have either 5 or 6 tiers. Tier 1 and often Tier 2 are generic drugs, with the lowest copays, sometimes even no cost," says D. Scott Harrod, a licensed Medicare agent in Kentucky. "Most plans have a deductible, and Tier 3 and above are usually brand name drugs with higher copays."

2) How do I enroll in a Medicare Part D plan in the state of New Hampshire?

To enroll in a Medicare Part D plan, you must be enrolled in Medicare Part A and/or Part B and live in the plan's service area. You can enroll in a Medicare Part D plan during your Initial Enrollment Period (IEP), which is the seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

You can also enroll in a Medicare Part D plan during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. During the AEP, you can switch to a different Medicare Part D plan or disenroll from your current plan if you no longer want coverage.

To enroll in a Medicare Part D plan, you can:

1. Compare different plans with our tool or find a local Medicare Agent to speak about what is going to work best for you.
2. Visit the official Medicare.gov Plan Finder and use the tool to compare Medicare Part D plans available in your area.
3. Contact the plan directly and enroll over the phone or online.
4. Contact the Medicare program at 1-800-MEDICARE (1-800-633-4227) and enroll over the phone.
5. Visit your local Social Security office and enroll in person.

"To enroll in a Medicare Part D prescription drug plan, start with Medicare’s Plan Finder. Enter your ZIP code, your prescriptions, and your preferred pharmacy so you can compare the plans available in your area," says Robin Dall, a licensed Medicare agent in Florida. "If you’d prefer to have someone walk you through it side by side, a local independent Medicare broker can compare plans with you at no cost."

It's important to note that you may be subject to a late enrollment penalty if you do not enroll in a Medicare Part D plan when you are first eligible. This penalty is an additional monthly premium that you will have to pay for as long as you have Medicare Part D coverage.

3) What is the deadline in New Hampshire for enrolling in a Medicare Part D plan?

The deadline for enrolling in a Medicare Part D plan depends on when you first become eligible for Medicare. If you are turning 65 and are enrolling in Medicare for the first time, you can enroll in a Medicare Part D plan during your Initial Enrollment Period (IEP), which is the seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

If you are already enrolled in Medicare and want to enroll in a Medicare Part D plan, you can do so during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. During the AEP, you can switch to a different Medicare Part D plan or disenroll from your current plan if you no longer want coverage.

It's important to note that you may be subject to a late enrollment penalty if you do not enroll in a Medicare Part D plan when you are first eligible. This penalty is an additional monthly premium that you will have to pay for as long as you have Medicare Part D coverage.

If you have a special enrollment period (SEP) due to a qualifying life event, such as moving to a new service area or losing other prescription drug coverage, you can enroll in a Medicare Part D plan outside of the regular enrollment periods. For more information about SEPs, contact the Medicare program at 1-800-MEDICARE (1-800-633-4227) or visit the official Medicare.gov Plan Finder.

4) Can I switch Medicare Part D plans and if so, how do I do it?

Yes, you can switch Medicare Part D plans if you are not satisfied with your current plan or if your needs have changed. You can switch plans during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. During the AEP, you can switch to a different Medicare Part D plan or disenroll from your current plan if you no longer want coverage.

To switch Medicare Part D plans, you can:

1. Visit the official Medicare.gov Plan Finder to compare Medicare Part D plans available in your area and choose a new plan.
2. Contact the new plan directly and enroll over the phone or online.
3. Contact the Medicare program at 1-800-MEDICARE (1-800-633-4227) and enroll in a new plan over the phone.
4. Visit your local Social Security office and enroll in a new plan in person.

It's important to note that switching Medicare Part D plans may impact your coverage and costs, so be sure to carefully compare plans and consider your needs before making a change. It's also a good idea to check with your current plan to see if there are any penalties or fees for disenrolling from the plan.

According to Mike Cooper, a licensed Medicare agent in Arizona, "Prescription formularies, the list of medications your plan does or doesn’t cover, can change year over year. What’s covered this year might not be covered next year, and if it is covered, the price you’re used to paying could change." Cooper recommends having your agent verify your latest list of prescriptions during the Annual Enrollment Period each fall.

If you have a special enrollment period (SEP) due to a qualifying life event, such as moving to a new service area or losing other prescription drug coverage, you can enroll in a Medicare Part D plan outside of the regular enrollment periods. For more information about SEPs, contact the Medicare program at 1-800-MEDICARE (1-800-633-4227) or visit the Medicare website.

5) I live in New Hampshire. How do I file a claim for reimbursement under Medicare Part D?

Most New Hampshire Medicare beneficiaries never need to file a Part D claim themselves. When you fill a prescription at an in-network pharmacy, the pharmacy runs your plan at the counter and you only pay your copay or coinsurance.

You may need to submit a reimbursement claim if you paid full price out of pocket for a covered drug — for example, if you filled a prescription at an out-of-network New Hampshire pharmacy while traveling, filled a prescription before your new plan's ID card arrived, or paid cash for a medication that should have been covered. In that case:

1. Pay for the prescription and ask for an itemized receipt showing the drug name, NDC number, quantity, date filled, and the amount you paid.
2. Download your plan's prescription drug reimbursement claim form from the member portal, or call the customer service number on the back of your ID card and ask them to mail one.
3. Complete the form with your Member ID, the pharmacy's information, and the prescription details.
4. Attach the itemized receipt and mail the completed form to the claims address listed on the form. Many NH plans also accept fax or online upload through the member portal.
5. Keep copies of everything you send. Most plans process reimbursement claims within 30 to 60 days.

If your claim is denied and you believe the drug should be covered, you have the right to appeal. Your plan's denial letter will explain the appeal process, or you can call 1-800-MEDICARE (1-800-633-4227) for help.

6) Are there any exceptions or exemptions to the Medicare Part D coverage rules in New Hampshire?

Yes, there are some exceptions and exemptions to the Medicare Part D coverage rules. Medicare Part D plans are required to cover certain drugs in certain categories or classes, but they may not cover all drugs in a particular category or class. For example, a plan may cover all drugs in the category of anticoagulants (blood thinners), but may not cover a specific drug in that category.

In addition, Medicare Part D plans may not cover drugs that are not considered medically necessary, such as over-the-counter drugs or drugs for cosmetic purposes. They also may not cover drugs that are experimental or investigational.

If you have a question about whether a specific drug is covered by your Medicare Part D plan, you can check the plan's formulary (list of covered drugs) or contact the plan directly. You can also contact the Medicare program at 1-800-MEDICARE (1-800-633-4227) for more information.

If you have a medical condition that requires a drug that is not covered by your Medicare Part D plan, you may be able to get an exception to the plan's coverage rules. To request an exception, you or your doctor can contact the plan and provide supporting information, such as medical records or a letter from your doctor, to show why the drug is medically necessary for you. The plan will review your request and make a decision about whether to grant the exception. By CMS rules, plans must respond to a standard formulary exception request within 72 hours, or within 24 hours if your doctor requests an expedited decision because waiting could seriously harm your health.

It's important to note that not all exceptions are granted, and even if an exception is granted, you may have to pay a higher cost-sharing amount for the drug.

7) Can I get assistance in New Hampshire with the cost of my Medicare Part D plan?

Yes, you may be able to get assistance with the cost of your Medicare Part D plan. Medicare Part D offers a program called Extra Help, which provides financial assistance to eligible beneficiaries to help them pay for their prescription drug costs. To be eligible for Extra Help, you must meet certain income and resource limits.

"If you have Medicaid, SSI, or a Medicare Savings Program, you typically qualify automatically for Extra Help with your Medicare Part D drug costs. This means your premiums, deductibles, and copays for prescriptions are significantly reduced," says Ann Sanfelippo, a licensed Medicare agent in Florida. "You usually do not need to apply separately because the benefit is assigned automatically through the Social Security Administration. If someone doesn’t automatically qualify, they can apply directly through Social Security based on income and asset limits."

8) What happens if I don't enroll in a Medicare Part D plan when I'm first eligible in the state of New Hampshire?

If you don't enroll in a Medicare Part D plan when you are first eligible, you may be subject to a late enrollment penalty. This penalty is an additional monthly premium that you will have to pay for as long as you have Medicare Part D coverage.

The amount of the late enrollment penalty depends on how long you went without creditable prescription drug coverage (coverage that is at least as good as Medicare Part D coverage). The penalty is calculated by multiplying the national base beneficiary premium, which is determined by Medicare each year, by the number of full, uncovered months you were eligible for Medicare Part D but did not have creditable coverage.

For example, if you went 24 months without creditable coverage and the national base beneficiary premium is $36.78 in 2026, your late enrollment penalty would be $36.78 x 24 = $882.72. This amount would be added to your monthly Medicare Part D premium for as long as you have the coverage.

In short: for every year a New Hampshire resident delays enrolling in Part D without other creditable drug coverage, the monthly premium goes up by roughly 12% of the national base beneficiary premium — and that surcharge sticks around for life.

It's important to note that the late enrollment penalty can be significant, so it's best to enroll in a Medicare Part D plan when you are first eligible to avoid this penalty. If you have a special enrollment period (SEP) due to a qualifying life event, such as moving to a new service area or losing other prescription drug coverage, you can enroll in a Medicare Part D plan outside of the regular enrollment periods and avoid the late enrollment penalty. For more information about SEPs, contact the Medicare program at 1-800-MEDICARE (1-800-633-4227) or visit the Medicare website.

9) Can I enroll in a Medicare Part D plan if I have other prescription drug coverage in New Hampshire?

Yes, you can enroll in a Medicare Part D plan even if you have other prescription drug coverage. However, you should carefully consider your options before enrolling in a Medicare Part D plan. If you have other prescription drug coverage, such as coverage through an employer or union, you should check with your plan to see if it is considered creditable coverage. If your current coverage is considered creditable, you may not need to enroll in a Medicare Part D plan.

10) What Happened to the Medicare Part D "Donut Hole" for New Hampshire Beneficiaries?

For years, the "donut hole" referred to a temporary coverage gap in Medicare Part D. After you and your plan had spent a certain amount on covered drugs, you paid a larger share of the cost until you hit catastrophic coverage. Effective January 1, 2025, the Inflation Reduction Act eliminated the donut hole and replaced it with a hard annual cap on what New Hampshire residents pay out of pocket for covered Part D drugs. The coverage gap is no longer a factor when you're planning your Medicare Part D coverage.

The cap started at $2,000 in 2025 and is indexed to inflation each year. For 2026, the annual out-of-pocket cap is $2,100. Once your covered drug spending hits that limit, you pay $0 for covered Part D prescriptions for the rest of the year. You can review current Part D costs on the official Medicare.gov Part D costs page.

"As of 1/1/2025, the donut hole was eliminated in favor of a maximum out-of-pocket for prescription drugs with a Standalone PDP plan or an MA-PDP plan," says Tabitha Self, a licensed Medicare agent in Tennessee. "However, it’s important to meet with a licensed Medicare broker to review your Medicare Part D options annually during the Annual Enrollment Period from October 15 to December 7 to ensure you’re on the best plan possible for the specific prescriptions you take."

These are some of the most common questions about Medicare Part D, but it's always a good idea to check with the Centers for Medicare & Medicaid Services (CMS) for the most up-to-date information.