Medicare can be complicated. Do you go with Parts A and B? Or do you opt for Medicare Advantage? What do you qualify for? What’s available in your area?
Adding to this, Medicare Part D, otherwise known as the Medicare Drug Plan, is completely separate from both Original Medicare and Medicare Advantage.
How do you know if you need the Medicare Drug Plan, or if you’re even eligible for it? Here we’ve got some of the basic information that you need to know to make sure your medications are appropriately covered, as well as what you need to know about changes to the plans in 2017.
Let’s look at how the Part D plan is structured for 2017. There are about 40 plans to choose from which adds to the confusion, all-the-more reason to work with a BGA agent for your Medicare planning.
After your Initial Enrollment Period (IEP-when you originally enroll onto Medicare) you may only change your coverage once a year during Annual Enrollment Period from October 15 to December 7.
If you do not sign up during IEP, a penalty will take effect when you do sign up unless you have proof of creditable coverage (usually employer coverage). That penalty is 1% for every month that you did not sign up for a Part D plan.
What is Medicare Part D?
Medicare Part D – also known as the Medicare Drug Plan – is additional coverage that Medicare recipients can opt to get that helps with the cost of prescription medicines. The plan is not automatic in the same ways that Parts A and B are. You must opt into Part D, and it is an additional and separate cost.
Like Medicare Advantage, there are different Part D providers in different areas, and each of the providers have some flexibility in what they are allowed to provide, or not. It’s very important that Medicare recipients look closely at the Part D plans they are considering signing up for to understand the coverage offered, what the co-pay or coinsurance amounts are, and all plan policies.
Can I Use it With Parts A and B? What About Advantage?
The Medicare Drug Plan is intended to be used as a supplement to Medicare Parts A and B, and as such they fit naturally together. The parts of the Original Medicare program offer very limited drug coverage, generally limited to what is prescribed in a hospital or administered at a doctor’s office.
Part D is intended to extend the coverage of the Original Medicare Parts A and B to include drugs prescribed by your doctor or after hospital care, typically the kinds of drugs you pick up from a pharmacy.
However, the Medicare Drug Plan does not work with the Medicare Advantage program. These programs typically have medication covered as part of the independent insurance offered with Medicare Advantage.
Am I Eligible for Part D?
If you are a Medicare recipient and are covered under Original Medicare (parts A and B), they you are eligible to receive additional coverage with Medicare Part D. If you are using Medicare Advantage, you are not eligible for Medicare Part D.
What is the Cost?
The cost of a Part D plan is dependent on a number of variables, including your location, the copay or coinsurance rates of the plan, and what your needs are. Instead of using a plan finder, you should talk to an agent that can directly assess your needs.
It’s also dependent on your income – for most people, the amount is simply the plan premium, but there is an added charge for those whose income, as a single filer, is more than $85,00/year or more than $170,000 if filing jointly.
In addition to the plan premium, different plans have different deductibles. Once the deductible is reached, there is also typically a copay or coinsurance amount. Medicare caps deductibles at $400.
Medicare Part D can help save you significant money if you have a need for regular prescriptions, or have costly prescriptions outside of a hospital stay, if you are on Medicare Parts A and B. It’s important to take the time to review what is offered as part of a Medicare Drug plan available to you to make sure you are getting the greatest value for your particular needs.
BGA Insurance Group helps seniors understand their current Medicare Part D Plan for 2017 or 2018 in the following states and cities:
- Pennsylvania (Philadelphia area)
- New Jersey
- Wilmington, Delaware
- Conshohocken, PA (office)
- Allentown, PA (office)
- Cherry Hill, NJ (office)
Learn more about our Medicare Advantage planning.