If anyone has any experience with Medicare Part D, I would appreciate comments on it, either pro or con.
More specifically, should I enroll in Part D: Why or Why not?
Thanks in advance.
Before her death, I helped my mother make this annual decision on prescription drug coverage. Each year it was a matter of economics in deciding what drugs she was taking vs the projected annual cost of these drugs without coverage compared to the cost with coverage plus the premium.
In her case, getting the coverage was a better deal but it depends on the drugs you may be taking. Medicare has a site where you can list your drugs and see what amount will be paid along with the premium.
Another consideration is whether you have access to employer prescription drug coverage as keeping it is usually a better option.
Thanks for the reply; I have no insurance other than Medicare A and B.
LouisB, are you a veteran? My husband takes 8 meds, and he gets them at a reasonable cost through the VA. Also, many common prescriptions are available cheaply now from Wal-Mart, Walgreen’s, and other pharmacies.
When I enrolled in plan D there was a penalty if you did not enroll (unless you already had an approved plan from your employer). It appears that is still true,
“Most Medicare beneficiaries must affirmatively enroll in a Part D plan to participate. Annual enrollment periods last from November 15 to December 31 of the prior plan year. This changes in 2011, when the enrollment period will last from October 1 to December 7.[2] Medicare beneficiaries who were eligible but did not enroll during the enrollment period must pay a late-enrollment penalty (LEP) to receive Part D benefits. This penalty is equal to 1% the national average premium times the number of years that they were eligible but not enrolled in Part D. The penalty raises the premium of Part D for beneficiaries, when and if they should elect coverage.”
I wish I was a veteran but a medical disability kept me out of the service. I am enrolled in Walgreen’s prescription plan and it seems to be helpful. I might just stick with that.
How long have you had just traditional Medicare (A & B)? Did you just become eligible?
If you want to avoid a penalty, you do need to have Part D. You can achieve this either through a stand-alone plan or by getting a Medicare Advantage plan that includes Medicare Part D (also known as a MA-PD; MA plans are required to include all the services Part A and B do; MA-PDs have to include at least Part A and B services, plus Part D). Part D premiums vary by region; MA plans can vary by county. The average Part D premium for 2011 is $32.34, I think. This premium is what will be used to calculate a late enrollment penalty. If you incur a late enrollment penalty, you can appeal it (ask Medicare to waive it), but if you can’t get them to waive it, it follows you for the rest of the time you have Medicare.
For what it’s worth, part of my job is managing a Medicare plan selection service. If you want more information, you’re welcome to PM me, but I don’t want to be a schil.
Yeah, if I enroll in Part D at all, I will wait until the open enrollment period. I’d like to know what it costs, if you wouldn’t mind telling me—that will save me a few more key clicks.
If you don’t enroll when you become eligible you will still pay a penalty even if you later enroll during an open enrollment period.
As as far as costs go that varies widely and depends on the state you live in and which plan you get.
What I don’t understand is WHY there is a penalty at all. I’m saving the program money by not using the plan.
My prescription costs per month are cheaper than the premium, but if I ever have to go on more medication later down the road, I’ll be penalized for this. Makes no sense whatsoever.
Being on Disability and Medicare, it’s not like I have money to throw around for all these premiums “cheap” though they may be!
The penalty is to encourage you to enroll before you need it. That way your premiums help pay for the people that have medicine requirements.
So, if I am working fulltime and have an Rx discount plan thru my Blue Cross medical insurance plan, and have only Medicare B (because I’m covered at work) do I or do I not want/need to get into M’care D. Will/can I be penalized if I get into it when I retire maybe next year?
Can you explain more about your employer-sponsored coverage? Does it include both medical and prescription with the discount Rx as secondary? Or do you just have the discount Rx plan and Part B?
Generally, your employer, if they sponsor the coverage, is required to provide you with a notice that tells you whether any employer coverage you have is creditable - as good as or better than Medicare Part D. Have you gotten a notice? If you have and the notice indicates that the coverage is creditable, you’re fine. Many employer plans are better than Medicare Part D’s standard (though not all). If you have received a notice and it says your coverage is NOT creditable, yes, you should probably join a Part D plan. If you don’t have a notice, you should call your employer and ask if the coverage they offer is creditable or not.
If you are able to defer enrollment in Part D now, you’ll be eligible for a penalty-free special enrollment period when your coverage ends (I believe it’s 2 months from the date your coverage ends or you receive notice, whichever is first).
Meanwhile, someone living at or below poverty level has to fork out money they need for other things like rent, gas, food, etc.? Still doesn’t make sense. I would think that the money paid in once you’re ON Medicare would be paying for your own usage of the program. Not having poverty level people paying for other poverty level people.
People at or below poverty level are usually subject to auto enrollment and eligible for low-income subsidy. Auto-enrollment automatically enrolls people with lower incomes meeting certain income and resource thresholds into a Medicare Part D plan to ensure they don’t have to pay a penalty. If they don’t like it, they have unlimited special enrollment periods (on a monthly basis, if they want) where they can disenroll from a plan that isn’t working and join one that works better.
Low-income subsidy helps those people pay for the coverage itself, regardless of penalty. So, based on a sliding scale, people meeting certain income and resource thresholds will pay more or less for a premium, deductible and copayments for coverage and drugs.
So, no, the impoverished are certainly not paying for other people at or below poverty level to have Medicare.
Edited to add: I think the 1% penalty is actually a bargain compared with what would happen if you were in the same situation in the individual non-Medicare market right now.
I was automatically enrolled in Medicare Part A on my 65th birthday. At my ex-wife’s insistence, I enrolled in Part B at the same time; a little later, an elder law attorney told us I was needlessly paying for Part B since I was covered by her federal employee Blue Cross Blue Shield insurance; I was paying for something I wouldn’t use given the BSBC plan was much better than Part B. I dropped Part B but had to re-enroll when she divorced me. I wasn’t charged a premium for late enrollment in Part B due to my previous enrollment, even though I dropped it. I don’t know if that circumstance would apply to Part D or not. I naively thought life would get easier in these Golden Years but it’s more complicated than ever. I certainly didn’t anticipate a divorce at my advanced age.
I’m sorry to hear about your divorce. I’m sure that sucked. Then you throw all the other decisions you have to make on top of that (like health coverage) and things become even more difficult. Medicare is a huge PITA for many, many people, and slightly moreso when dealing with change of life events.
The elder law attorney was right - it did make sense to defer, especially since your wife was receiving federal retiree benefits. Can I ask when that coverage ended? If you lost coverage, your special enrollment period would apply to Part B and Part D. The idea is that you have to have both A and B to get D, with certain exceptions that don’t apply to you. So, if you earlier had just A and you just now got B, then you also have a chance to get D.
My wife had not yet retired at the time we saw the elder law guy; it was her intention to drop me from her health insurance but he pointed out that she most likely would not be allowed to do that unless and until we were divorced. I had forgotten that detail but she, apparently, did not even though it took her another eight to ten years to act on it. So, I was dropped from my ex-wife’s BC-BS on the date of our final divorce decree: July 7, 2010. My Medicare Part B coverage became effective on that date. At the moment, my prescription costs are not that onerous but they might well be at some future point. It’s a cinch they won’t be reduced. I have had to stop using Welbutrin XL due to the cost; I am now using plain old Welburtin which is NOT as effective as the XL. I can tell that my depression has worsened as a result of that change, but that isn’t really relevant; it is just an observed result.
As an editorial comment, I was refused public assistance and food stamps because my income places me above the official poverty level----I don’t think I want to know how people at that level manage to live.
Here’s my take on your situation (and I wouldn’t take this as gospel): It doesn’t sound like you accepted a temporary continuation of coverage after your divorce was finalized. It’s good that you enrolled in Part B when you had the chance. I personally think you should get Part D (definitely not acting in a professional capacity - just my opinion), especially if you know your drug costs will rise and can’t afford to get those prescriptions that work best for you.
But, since you didn’t have creditable coverage for more than 63 days after the date you lost coverage, it’s very possible that you might have to pay a penalty. Even if your Part D coverage isn’t effective until 1/1/11 and you have to pay a penalty for all those months you didn’t have coverage, that penalty will still probably be only up to 3% - 5% of $32.34, which I think is under $2. If you disagree with the penalty or felt you weren’t adequately informed, you have the chance to appeal the penalty.
Now, if you’ve applied for food stamps and public assistance, even if you don’t get Medcaid, there’s a possibility you could be eligible for the low-income subsidy to help pay for your prescription costs. If you think you might be eligible, then you should apply. Eligibility is based on a sliding scale and doesn’t necessitate that you have Medicaid. So, even if you’re not at or below the poverty level, you could receive extra help. You should check out the new Medicare & You handbook for 2011 - they have the income thresholds on page 86 or you can search for Extra Help. Also, there are often corporate and state discount programs that can help you pay for your prescriptions. I would look into those now by contacting your local SHIP or Area Agency on Aging. I believe you can use these programs with or without Medicare, but they could tell you more.
Additionally, if your prescriptions are so expensive that they put you in the donut hole next year, you’ll get a 50% manufacturer discount on brands and a 7% discount on generics and it won’t slow your progression through the donut hole.
That’s just my two cents’ worth. Again, I’m speaking strictly off the record and I would probably talk to the elder law attorney in case he/she has a different take.