Approaching 65 or retirement can be a time of celebration, but also a time of confusion and overwhelm when it comes the transition from health insurance to Medicare. There are Parts A and B original Medicare, then what’s referred to as Part C for Advantage Plans, but also Supplements and Part D Prescription Drug Plans. It’s a lot, right? Although it sounds like an alphabet soup puzzle, it doesn’t have to be over complicated. Let’s focus on the Part D Prescription Drug coverage for now. This is sold by private companies, in addition to the medical coverage on a Supplement, that goes with original Parts A and B.
How do I choose a Part D Plan?
- You can visit medicare.gov and select the tab titled “Drug Coverage (Part D)”. If you are going the route of an Advantage Plan, there will be Part D coverage built into that plan. But if you’re opting for a Supplement, such as the ever-so-popular Plan F with Florida Blue, you’ll need a separate Part D Plan.
- This Part D section of medicare.gov is a great tool to compare plans that are specifically offered in your zip code. You can also look up actual medications in their formulary to see what your cost would be, based on what plan and pharmacy you prefer.
- As you compare coverage, you may see things like copays and coinsurance that apply to certain drugs. There is also a coverage gap referred to as the “donut hole”. In 2019, the guideline is that once you and your drug plan have spent $3,820 on covered medications, you enter the “donut hole”. Once in that coverage gap, you’ll pay no more than 25% of the plan’s cost for covered brand-name drugs. In 2019, Medicare will pay 63% of generic drugs during this time as well.
When can I enroll?
- Time frames to consider: You can choose and enroll in a Part D plan within the same 7 month window as regular Medicare…. 3 months before your 65th birthday month until 3 months after. Outside of that period, the late enrollment penalty will apply. And if your health status or prescribed medications happen to change throughout the year, you can switch Part D Plans during open enrollment, which begins October 15th, 2019.
What if I don’t enroll on time or choose not to have a Part D Plan?
- It is advised that even if you don’t currently take any regular medications, still enroll in some sort of Part D coverage to avoid the late enrollment penalty. The current penalty fee in 2019 is 1% of the “national base beneficiary premium” of $33.19 times the number of full, uncovered months you didn’t have Part D or creditable coverage once becoming eligible. The monthly penalty is then rounded to the nearest $.10 and added to your monthly Part D premium…. Forever.
- Keep in mind that your health can change or decline quickly and the cost of prescription medications are at an all-time high. It’s more important than ever to have Part D coverage and it’s worth every penny to avoid astronomical out of pocket expenses and the forever-haunting penalty that comes from going without.
This can all seem very complicated so it’s really best and most accurate if you look up your specific medications and compare plans based on your actual needs. We are always happy to help guide you through this process and make recommendations or answer questions anytime.