People With Medicare
Joining, Picking and Switching Plans in Nursing Home Care
How do I join?
You will join like other people with Medicare. You can use the same web tools to help you pick your plan. Go to the 7 Simple Steps to learn the basics. Social service staff or family members may be able to help you with this.
Who can enroll me in the Medicare Prescription Drug Coverage?
If you are not able to enroll yourself in a Medicare drug plan, your authorized representative can do it for you. Each state decides who can be your authorized representative. See the Authorized Representative section for more information. In unusual circumstances, some states allow state, nursing home or other institutional staff to enroll or disenroll a person with Medicare in drug plans.
Will everyone in the nursing home be in the same Medicare Prescription Drug Plan?
Probably not. There are many Medicare Part D plans in each area for people to select. Each person who lives in the nursing facility will pick the Medicare drug plan that is best for him or her.
Can I choose from all the plans if I live in a nursing home?
Yes. Every drug plan must have pharmacies in its network that work with long-term care facilities. You should join a plan that works with the pharmacy your nursing home uses. They must be able to send drugs to your facility for you when you need them, 24 hours a day. They must be able to give all the drugs to the nursing home that you have used in the past. If your nursing home gives you intravenous treatments (IVs), your Medicare drug plan has to make sure you have them.
Can I pick my own plan or will I be assigned to one?
You are strongly encouraged to pick your own plan. That way, you can find a plan that covers all or most of your drugs.
Can I switch plans?
When you enter or leave a nursing home, you may switch your plan.
In addition, you have a Special Enrollment Period for as long as you live in the nursing facility. This means you may switch plans as often as once a month.
Do I have to join a Medicare drug plan?
No, you do not. But if you decide not to join a plan:
- You will have to pay for your drugs yourself, unless you have another insurance or program that is covering your drugs.
- You will be able to join Medicare coverage during the next open enrollment period, which runs from October 15 to December 7. Your drug coverage would not start until January 1.
- If you decide to join a Medicare drug plan in the future, you will have to pay higher premiums for as long as you have Medicare drug coverage. (See Penalty for Enrolling Later).