Understanding Medicare Part D
Understanding Medicare can be very confusing. We have done our best to simplify Medicare Part D. Click on the questions below to be taken to each answer. Simply click back to the top to be taken to the various questions again.
- How much does Medicare Part D cost?
- Who qualifies for Medicare Part D?
- What are some things to consider when looking into Medicare Part D?
- What happens if I can’t afford Medicare Part D?
- What kinds of drugs aren’t covered by Part D prescription drug plans?
- How do I decide which Plan D drug plan is best for me?
- My drug plan is not being offered next year, what do I do?
- I am covered by Medicare, but I don’t take any medications at this time. Should I still sign up for a drug plan?
- I am signed up for Medicare but not a Part D drug plan. Can I still sign up for Medicare Part D at a later time?
- If I sign up for a Part D plan during the Open Enrollment period, when will the coverage take effect?
- Even with Part D coverage, I still need to pay a lot out-of-pocket for a prescribed medication. Is there a way I can pay less?
How much does Medicare Part D cost?
- Medicare Part D is provided by private insurance companies that contract annually with the government.
- Pricing depends on a variety of factors.
- The three main factors to consider when determining plan options are as follows:
- First, the client’s specific list of current medications and dosage.
- Second, a client’s preferred pharmacy.
- Third, the client’s specific plan option. If the client chooses a Medicare Advantage plan, the drug plan will range between $0-$49/month. If the client opts for a Stand Alone Drug plan, the plans vary between $20-$100/month.
What are some things to consider when looking into Medicare Part D?
- What are your current prescriptions with dosage?
- Are you taking maintenance prescriptions or any prescriptions on an “as needed basis.”
- Are you taking generics or can you take the generic form?
- Competing pharmacy costs vs. Mail Order.
- Rate shop the different plan copays on all current prescriptions.
What kinds of drugs aren’t covered by Part D prescription drug plans?
- Since each drug plan decides which drugs not to cover on its formulary, the list here is not complete.
- However, plans usually do not cover: Weight loss or weight gain drugs; drugs for cosmetic purposes or hair growth; fertility drugs; drugs for sexual or erectile dysfunction; over-the-counter drugs.
I am covered by Medicare, but I don’t take any medications at this time. Should I still sign up for a drug plan?
- Yes, you should enroll during your initial enrollment period to avoid any late penalties. You never know what will happen next week, next month or next year.
- Your ability to enroll is restricted.
- The only time you can enroll outside of your Initial Enrollment Period is during the Annual Enrollment Period, October 15- December 7th. If you forgo enrollment during this period, you may find yourself uninsured for a length of time.
- Also, if you opt out of enrollment when first eligible, you are charged with a Late Enrollment Penalty each month you go uninsured. This penalty follows you for the rest of your life!
- We typically suggest enrolling in the lowest priced Medicare Part D plan to avoid the penalty.
- You can easily change to higher priced coverage in the future with no underwriting during the Annual Enrollment Period.
- In 2018, the lowest priced plan in most states is roughly $20/month.
I am signed up for Medicare but not a Part D drug plan. Can I still sign up for Medicare Part D at a later time?
- Maybe. If you took Medicare A/B and maintained coverage from a job/retiree plan, spouse’s coverage or another source, you may be eligible to enroll in Medicare Part D once that coverage ends.
- For example, if at 65, you enrolled in Medicare Part A only and deferred Part B because you had access to credible employer coverage, now at 68 you are retiring and have access to Medicare Part B and D under a special enrollment period.
- Having credible employer coverage qualifies you for a special enrollment period, which allows you to enroll in Part B and D without penalty or concern about pre-existing conditions.
If I sign up for a Part D plan during the Open Enrollment period, when will the coverage take effect?
- If you elect to change your Medicare drug coverage during the Annual Enrollment Period (10/15 – 12/7 of each year) your coverage will begin on January 1st.
- We suggest getting a refill in late December under the old plan to avoid any issues with the transfer.
Even with Part D coverage, I still need to pay a lot out-of-pocket for a prescribed medication. Is there a way I can pay less?
- Yes! There are a variety of programs that are income based and available to you.
- Some are offered by the federal government, while others are provided by the manufacturer of the specific medications. Because the majority of these programs are income based, we recommend you have the following handy:
- Combined household income
- Current asset-level (add up funds in a checking account, savings, IRA, 401(k), etc) and get a ballpark number.
- Once you have these figures, you can call us to get an idea of what is available to you. Be wary of companies that want to charge you a fee to find programs as many of them are scams!
- If your income is under 400% of the Federal Poverty Level, about $40,000/year for an individual and $65,000 for a husband/wife, you probably qualify for some sort of assistance.