TMZ INSURANCE SOLUTIONS
Medicare Part D
Medicare Part D insurance is sold by private prescription drug insurance companies to help you pay for your prescription medications. As long as you are enrolled in either Part A or Part B of Medicare, you can purchase a Part D plan. Many Medicare Advantage Plans include Part D coverage.
If your healthcare coverage plan is to have Original Medicare only, or a Medicare Supplement, a Part D plan would need to be purchased separately in order to be covered for prescription medication.
Whether your drug coverage comes as a stand-alone Part D plan, or is included in a Medicare Advantage Plan, it is important to remember prescription drug plans are not all the same. Many are surprised to learn that these plans are not required to cover all approved medications. An agent can help compare your list of medications to the various plan formularies to ensure your medications are included and compare co-pays prices.
Those new to the world of Medicare may mistakenly believe that if they are suddenly prescribed an expensive medication, they can just quickly enroll in a Part D plan to cover it. Not true. Enrollment can only take place during a valid enrollment period. Additionally, there are penalties for late enrollment if you decide to enroll after you are first eligible. If you are assessed a penalty, that penalty is permanent. The amount of the penalty can go up based on a federal formula. It is therefore important to purchase Part D on time!
What if I have employer group coverage? If you are over age 65 and have employer group coverage that is defined as "credible coverage" by Medicare, and it includes prescription drug coverage that is at least as good as Medicare Part D drug coverage, you can probably keep that employer plan and postpone enrolling in a Part D plan without penalty. Check with your employee benefits administrator to ensure your Prescription Drug plan is credible as defined by Medicare.
Your initial eligibility in that case begins when that coverage terminates. In this situation, you have a "Special Enrollment Period," which is the two months after the group coverage ends to sign up for a Part D plan. After that two month period ends, the Medicare Part D late enrollment penalty would begin. Check with your employee benefits department if you are unsure if your plan is considered creditable.
When to enroll to avoid a late enrollment penalty: In order to avoid a late enrollment penalty, most should and will enroll during their "Initial Enrollment Period," which begins three months before the month of their 65th birthday, and ends three months after the month of their 65th birthday. There is also the aforementioned “Special Election Period” that takes place after leaving a "credible coverage" group plan.
Again, each plan has its own unique formulary of covered prescriptions, so it’s important to compare your prescriptions to those listed on each plan. We can help you analyze the differences between plans. In addition, you'll want to review your plan annually even if you do not add or change medications. That research is an important piece in choosing and keeping the plan that is right for you.