Medicare Part D Enrollment
Understanding Part D special enrollment periods
Most everyone knows that when you are about to become eligible for Medicare, you should choose a Medicare approved drug plan. What many people don’t know is that Medicare Part D enrollment is not limited to first becoming eligible for Medicare or taking advantage of the Annual Enrollment Period (AEP) that takes place each year between November 15th and December 31st.
As a Medicare beneficiary, you may be able to take advantage of a Special Enrollment Period (SEP), where you are able to change your Medicare Part D enrollment. The following list defines the SEP and details the changes that can be made.
You are eligible for both Medicare and Medicaid. Also know as being dual eligible, you are able to join, change or drop prescription drug coverage anytime.
You qualify for extra help paying for your Part D coverage. You have the right to join, change or drop prescription drug coverage anytime.
You are enrolled in a State Pharmaceutical Assistance Program. You can join a prescription drug plan once during the calendar year.
You dropped a Medicare supplement (Medigap) the first time you enrolled in a Medicare Advantage Plan. Within the first 12 months of being enrolled in the Advantage Plan, you can drop that plan, return to original Medicare and pursue Medicare Part D enrollment.
You have a severe or disabling condition and there is a Chronic Special needs Plan available for you condition. You can join a Chronic Special Needs Plan that will include Part D prescription drug coverage. You can join anytime, but have lost your ability to make additional changes until your Annual Enrollment Period.
You no longer qualify for a Chronic Special Needs plan because you no longer have the qualifying health condition. You can switch plans, but only have 3 months from losing your Chronic Special Needs Plan to do so.
You joined a plan or chose not to join a plan due to an error by a federal employee. You have 2 months from the time you receive the notice of the error to chose another plan or drop prescription drug coverage.
You were not informed that your other private drug coverage was not not as good as a Medicare Part D Plan. You have 2 months to join a plan from the date that you receive notice of the error from Medicare.
You were not informed that you were losing private drug coverage that was as good as Medicare Part D coverage. You have 2 months to join a plan from the date that you receive notice of the error from Medicare.
You move to a new address that is not in your plan’s service area or, is in the service area, but you have other plan options. If you inform you plan prior to your move, you have one month before the move and 2 months after the move to change you Medicare Part D enrollment. If you inform them after you move, you will have the remainder of the month in which you inform them and an additional two months to make a change.
You move back to the USA after living outside of the country. You have 2 full months after the month that you move back to join a plan.
You reside in, or are moving into or out of a skilled nursing facility or meet the institutional level of care. You can join, switch or drop plans anytime you are confined to a skilled nursing facility or for 2 full months after the month that you move out.
You leave employer group or union coverage, including COBRA. You have 2 full months after the month that you leave your prior coverage to pursue a Medicare Plan or Medicare Part D enrollment.
You involuntarily lose your other drug coverage that is deemed creditable drug coverage or you plan changes and your other drug coverage is now considered non-creditable coverage. You have 2 full months to enroll in a Part D Plan after the month you coverage ends.
You have drug coverage through a Medicare Cost Plan or have a PACE plan and drop coverage. You have 2 full months to enroll in a Part D Plan after the month that you leave your previous plan.
You are no longer eligible for your State’s Medicaid program. You have 2 full months after the month that you are deemed non-eligible, or if you lose your Medicaid coverage for the following year, you can switch between January 1st and march 31st.
You are enrolling in other creditable drug coverage, such as VA or Tri-Care. You are able to drop your Part D anytime.
You have the opportunity to enroll in other coverage offered by your employer or union. You are able to make a change whenever you are offered this coverage.
Your Medicare Advantage Plan or prescription drug plan is not renewed for the following year. You can make a change between October 1st and March 31st.
Medicare terminates your plan’s contract. You can switch until 1 full month after you plan is terminated.
You are released from jail. Your chance for Medicare Part D enrollment lasts for 2 full months from the month that you are released from jail.
Keeping it all straight
As you can see, it’s not all about having a choice during the AEP. Only by being aware of your Medicare Part D enrollment options can you maximize your opportunity to get the best plan. The above list of special enrollment periods demonstrates that it is normally when you experience some type of change in your status or the status of you current plan, that you can make a change.
Insurance agents must be certified by each insurance company they wish to represent as it relates to Part D and Medicare Advantage plans. Conferring with an agent is always recommended.
Learn about your Medicare Advantage enrollment options.
Finding Medicare Part D Plans
Finding the best Medicare Part D Plans
You know that you need to choose a Medicare Part D Plan, but are confronted with dozens of choices. Finding Medicare Part D Plans is not that difficult if you know where to look and know what you’re looking for.
It’s hard to make a choice if you only rely on television commercials or direct mail that seems to be delivered by the truck load this time of year. The large well known carries are hammering away. AARP Medicare Part D, Humana Part D, Cigna part D, Wellcare Part D and many others seem to dominate the airwaves. But are they the best choice?
When it comes to finding Medicare Part D Plans, it’s wise to use your official resources. The Medicare Publication, Medicare And You and the official Medicare Website are a great resource to look at all your options.
Evaluating Medicare Part D Plans
Many people make the mistake of only looking at the monthly premium and then assume that the lowest premium is the best value. But there are several factors to consider beyond the monthly premium for Medicare Part D Plans. Other factors that you should consider include:
- The Plans co-pays. Co-pays can vary from one Part D Plan to another. These differences can make a difference in your overall annual costs.
- Whether or not there is an annual deductible. Medicare Part D Plans can include an annual deductible up to $310 for 2010.
- Which tier your individual prescriptions are in. Having a low monthly premium and having some of your prescriptions listed in a higher more expense tier than another Medicare part D Plan may cost you more over the course of the year.
- Whether or not all your drugs are included in the plan’s formulary. If a drug is not in the formulary, you will be paying for it out of pocket.
- Is there some coverage in the coverage gap (donut hole)? Several plans include some level of coverage in the donut hole. These plans will normally have a little higher premium, but it may be worth the higher cost if you know that you will more than likely reach the donut hole.
As you can see, there are several other factors that need to be considered when you are trying to find the best Medicare Part D Plan. Take the opportunity to utilize the official resources that are available.
Also, evaluate the Medicare Part D Plan that is included in a Medicare Advantage Plan. If your prescriptions are a large part of you annual health care cost, you should evaluate the Part D plan in an Advantage Plan just as you would a stand alone Medicare Part D Plan.
Part D Late Enrollment Penalty
How to avoid the Medicare Part D late enrollment penalty
You may be asking yourself, “what is the Part D late enrollment penalty and how do I avoid it?” Many Medicare beneficiaries don’t even realize that there is a part D late enrollment penalty.
The official Medicare publication. “Medicare and you”, states that:
The late enrollment penalty is an amount that is added to your Part D premium. You may owe a late enrollment penalty if one of the following is true:
You didn’t join a Medicare drug plan when you were first eligible for Medicare, and you didn’t have other creditable prescription drug coverage.
You had a break in your Medicare prescription drug coverage or other creditable coverage of at least 63 days in a row.
Enroll in Part D when you are eligible
The best time to enroll in a Part D prescription drug plan is when you first become eligible. Often, a Medicare beneficiary may mistakenly believe that they can save some money by not enrolling in a Part D Plan because they are prescribed little or no medications.
Don’t fall into this trap. You could end up with higher costs due to the late enrollment penalty. Also, it’s called insurance for a reason. Even though you are on little or no prescription medicine, that is not an indicator as to what may happen in the future.
Here are some tips from the publication “Medicare and You”
Here are a few ways to avoid paying a penalty:
Join a Medicare drug plan when you’re first eligible.
You won’t have to pay a penalty, even if you’ve never had prescription drug coverage before. Don’t go for more than 63 days in a row without a Medicare drug plan
Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, or the Department of Veterans Affairs. Your plan will tell you each year if your drug coverage is creditable coverage. Keep this information, because you may need it if you join a Medicare drug plan later. Let your Medicare drug plan know if you had other creditable coverage.
When you join a plan, you may get a letter asking if you have creditable coverage. Complete the form they send you. If you don’t tell the plan about your creditable coverage, you may have to pay a penalty.
To compare 2010 Medicare Part D Plans visit the official Medicare Website and follow the link to compare plans in your area. It’s much more user friendly if you select “Plans in your area with drug coverage”. You will be asked to enter your State and County of residency. As an example, if you are comparing 2010 Medicare Part D prescription drug plans in Cook County Illinois, you will see that there are 46 stand alone Part D Plans to choose from.
You can also compare 2010 Medicare Advantage Plans in Cook County Illinois or where ever you reside. this tool is invaluable to do your preliminary research before you speak with an agent or go to a plan’s website.
2010 Medicare Part D Drug Costs
2010 Medicare Part D Premiums Are Increasing
Medicare beneficiaries are scrambling to compare 2010 Medicare Part D prescription drug plans. The annual enrollment period (AEP) runs from November 15 through December 31st.
Insurance companies that offer Medicare Part D plans can adjust their plans on an annual basis. The AEP is the Medicare beneficiary’s opportunity to determine whether or not they would like to keep their current Part D plan or whether they should shop and compare Medicare Part D plans.
The “moving parts” of Medicare Part D
When comparing 2010 Medicare Advantage Plans it’s important to look beyond the monthly premium. There are several aspects that can affect how much you pay for your prescription drugs.
- The monthly premium ia an obvious contributor to cost.
- Whether or not the plan has an annual deductible can affect your prescription drug costs.
- Co-payments can vary from plan to plan.
- What “tier” a drug is listed in can vary from plan to plan.
- The plan’s drug formulary itself can affect your overall costs.
It’s important to understand the overall picture as it relates to your Medicare Part D costs. Just because a plan has, what seems to be a reasonable premium, it doesn’t mean that it will necessarily cost you the least amount of money.
Many 2010 Medicare Part D Plans have included an annual deductible. Deductibles for 2010 can be as much as $310.
It’s wise to look beyond the monthly premiums and c0-pays to see what drug tiers your prescriptions fall in. just because one plan categorizes a prescription as tier two, does not mean that another plan will do the same.
The dreaded donut hole
The coverage gap or donut hole can put a real dent in your budget. You reach the coverage gap after the total prescription costs paid by you and the plan reaches $2830. Some plans offer some degree of coverage in the donut hole. Be sure to take this into consideration if you expect to reach the donut hole.
Another area to compare is the mail order pharmacy benefit. You can generally save some money with a three month supply delivered through the mail.
The resource that can help you make sense of it it all is the official Medicare website. Once on the website you can compare plans in your area to determine which may be right for you. this is your best and most objective resource to compare 2010 Medicare Part D prescription drug plans.