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Medicare Part "D"

Medicare Part "D" is offered by private insurance companies only.  It is not purchased from Medicare as many believe but may be deducted from ones social security check like part "B".  Open enrollment begins Nov. 15, of each year for a January 1 effective date.  Enrollment is optional, but there is a 1% premium penalty for each month you wait beyond the date that you first become eligible, which is age 65 for most individuals.  And that penalty will stay enforce for as long as you remain in Part "D".  Those just turning age 65 do not have to wait till the open enrollment period to sign up.

If you have a traditional Medicare supplement plan that includes prescription (for example, plan H, I or J) than the penalty will also apply if you wait beyond the deadline.  If you have one of these plans you must change to a different plan before you can add Part "D".    Before you choose a plan make sure you understand how your drugs will be covered.  Each Part "D" drug plan will have a government approved list of drugs it covers, called a formulary or a preferred-drug list.  This list will vary from company to company. 

There will be many variations of the base plan available but this is how the base plan will work in general.  First there will be a $250 deductible where you pay 100% of the cost.  For the next $2000 you pay 25% of the costs.  For the next $2850 you again pay 100%.  Beyond this point you pay 5% and the plan pays the rest.  Insurance companies can offer improvements to this such as a flat co-pay instead of a percentage, and many will offer reduced cost for ordering through their mail order system.  Another option many companies will offer is having no deductible and "gap coverage" if a generic is used.  Many companies will also offer the choice of co pays for both generic and brand drugs.  For example $2 for preferred generic and $20 for preferred brand. 

If all this is just too confusing, just give me a call and tell me what your situation is and I will tell you what your choices are.  In summary, if you spend more than $100 per month on prescriptions, you will save something.  If you wait beyond the date that you first become eligible to enroll, you will pay a premium penalty of 1% per month or 12% per year with no ceiling.  You will pay the penalty for as long as you have the plan.  Since one can't predict the future, I can't justify anyone taking such a risk.

The only way to tell which plan is best for you situation is to get a list of all your medications with the dosage on each and run this thru a computer program that I have.  This program will tell you exactly which plan and which company has the most economical plan for your situation.