Drug Plans

There are many Medicare drug plans that will save you money and provide better prescription benefits provided to all with at least Part A Medicare.

Medicare Part D is the Medicare prescription drug benefit, created by the Medicare Prescriptions Drug, Improvement, and Modernization Act of 2003. It is offered to all individuals with at least Part A Medicare.

1. Medicare Prescription Drug Plan (PDP) Stand Alone Plan. These plans add prescription drug coverage to Original Medicare, Medicare Supplements, some Medicare Cost Plans, some Private Fee-For-Service Plans (PFFS) and Medicare Savings Plans (MSA).

2. Part C Plan or Medicare Advantage Plan. You can also acquire a PDP as part of a Medicare Part C Plan or Medicare Advantage Plan that combines Part A, Part B and Part D all into one plan called a Medicare Advantage Prescription Drug (MAPD) Plan. These plans can be in the form of an HMO, HMO-PSO, PPO or PFFS.

Important considerations about enrolling in the Medicare Drug Plan are current drug coverage, your income and how much you currently spend on drugs. If you currently have drug coverage that is at least as good as or better than Medicare’s basic drug coverage, and you are satisfied with it, you might want to keep it. If you elect a Medicare private drug plan, you may lose your creditable drug coverage and be unable to get it back at a later date.

If you have credible coverage, you can join a Medicare private drug plan later without penalty. The carrier that provides your drug benefits, such as an insurance company, employer or state program, should send a notification to you annually notifying you as to whether your coverage is credible. Please be aware that this information may not come as a separate piece of mail. It may be included with other information, such as a plan newsletter.

If you are not notified regarding the credibility of your coverage, you should call and ask for verification in writing. You will not be required to pay a penalty if you can show you received inadequate information about whether your coverage was credible.

If you have current coverage from a current or former (retiree coverage) employer, you should ask the Human Resources Department or Benefits manager if and how your coverage will work with Part D. Some employer plans do not work with Part D at all and, if you join a Part D plan, you could lose your employer coverage and not be able to get it back.

If you have no drug coverage or have drug coverage that is not as good as Medicare Part D, you need to think about whether the Medicare drug benefit will help you. To decide if the Medicare drug benefit will help you, here are some questions to consider:

CAN I GET HELP PAYING FOR MEDICARE DRUG COVERAGE IF MY INCOME IS LOW?*

Many state assistance programs coordinate with the Medicare prescription drug benefit and help with the costs of Part D coverage (many of these programs require you to have Part D). A few states have programs that do not require that you join Part D and offer good coverage that is creditable. You can delay in enrolling in the Medicare drug benefit without penalty in these states. If your state's SPAP is creditable, they must send you a written notification. If you do not receive a notification, but believe your SPAP is creditable, you should call and request the information in writing.

WOULD A MEDICARE DRUG PLAN SAVE ME MONEY?

Many state assistance programs coordinate with the Medicare prescription drug benefit and help with the costs of Part D coverage (many of these programs require you to have Part D). A few states have programs that do not require that you join Part D and offer good coverage that is creditable. You can delay in enrolling in the Medicare drug benefit without penalty in these states. If your state's SPAP is creditable, they must send you a written notification. If you do not receive a notification, but believe your SPAP is creditable, you should call and request the information in writing.

To determine this, start by making a list of your prescriptions, the dosages, and what you pay each on a monthly basis. Then compare what you pay now with what you would pay if you enrolled in a plan (including the monthly premium). If you have high drug costs, you may save money through a Medicare drug plan. But make sure the plan you choose covers the drugs you need and works at the pharmacies you use most frequently. If you have low drug costs, having Medicare drug coverage could cost you more now, but could protect you from high drug costs in the future. There may be a Medicare drug plan in your area with a low monthly premium you can afford.

If you do not have creditable coverage and do not enroll in the Medicare drug benefit when you are first eligible, you may pay a penalty if you enroll later. The penalty may be small, but typically you will pay a penalty for as long as you have Part D coverage and the penalty may increase each year. The penalty is 1% of the national base beneficiary premium for each month that you do not have credible coverage. In 2019 that would be 1% of $33.19 ($32.27 in 2020)**. Usually, you will not be able to enroll until the next enrollment period (October 15 – December 7). If you enroll during this period, your coverage will become effective on January 1.

If you do not have creditable coverage and are not eligible for Extra Help, you will need to wait until Medicare's Fall Open Enrollment (sometimes called the Annual Election Period – AEP) to sign up for a drug plan. If your drug needs change during the course of the year, you will not have drug coverage. Still, there may be other low-cost ways to obtain the drugs you need. To find out, give us a call to speak to one of our customer service representatives to discuss other Prescription Assistance Programs that maybe available to you.

If you are eligible for Extra Help, you will be granted a Special Enrollment Period to sign up for a Medicare prescription drug plan. You will also not have to pay a penalty for late enrollment, if you did not have creditable coverage. You may also qualify for a Special Enrollment Period for other reasons.

Sources: *http://www.ncoa.org/assets/files/pdf/center-for-benefits/part-d-lis-eligibility-and-benefits-chart.pdf
**http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf