How Do You Get Part D?

If you are or about to be in the Medicare eligible market and will not continue receiving your health insurance from your job, you will need a Medicare Part D, also known as a prescription drug plan. As mentioned in my previous article, if you choose a Supplement or Medigap policy you will have to decide on the appropriate Part D plan. These plans have an additional monthly premium ranging from the low teens to about $100, depending on the carrier. More than likely, you will also have monthly drug costs, depending on your coverage and health.

Many people assume that their Part D plan has to be from the same carrier that their supplement/Medigap plan is from. However, this is not the case, and most often, a plan from a different carrier is most appropriate.

Here comes the real fun part. Even if you are not taking any prescription drugs you still have to have a Part D drug plan when you become Medicare eligible. Otherwise you will pay a per-month penalty when you finally do enroll in Part D. The monthly penalty is actually not that high (about .35 per month for 2018 or $4.20 for the year). However, if you go several years without Part D coverage you might be paying an additional monthly premium of $15 to $20 for no reason.

(Keep in mind that there are some exceptions. For instance, if you have something called creditable coverage for drugs from work, or another source such as VA or Tricare, there is no Part D penalty when you enroll.)

For those who choose an Advantage Plan instead of a Supplement or Medigap policy, Part D is automatically included whether the Advantage plan has a monthly premium or not.

How Are Drug Costs Determined?

All prescription drugs are divided into what is called formulary (a list of drugs, both brand and generic, by each carrier) and tiers, numbered 1 through 5. Usually, the lower the tier, the lower the cost.

However, here comes even more fun. Just to make it more complicated, every carrier has their own formulary and tiers. So, a tier 1 or 2 drug with Carrier A with a very low monthly cost could be a tier 3 with Carrier B and cost several times more. Also, within the same tiers, prices can vary immensely depending on the carrier. For example, I have seen one carrier’s group drugs in tiers 1 or 2 with zero cost for the year and another carrier have the same exact drugs cost $800 or $1,000 for the year.

In addition, carriers can change the tiers and costs of drugs during the plan year. This can cause a large increase or decrease in monthly and yearly drug expenditures for you.

Controlling or Capping Your Drug Costs

Some of you might have heard of something with Part D called the “Doughnut Hole” and Catastrophic Coverage for those that have several thousand of drug costs per year. Certain states, New York being one of them, have some very specific solutions for Doughnut Hole and Catastrophic Coverage. Please consult your Medicare adviser or state for details.

As with your Medicare Part C plans, there is no magic formula to control or to cap drug costs. Proper research by an independent, unbiased resource is always my recommendation, as they have the skill and expertise to offer you solutions for your unique situation.

by Robert Remin | Nov 30, 2017

 

Author: Robert Remin

Source: JEWISH LINK

Retrieved from: www.jewishlinkbwc.com

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