Medicare Part D -- Prescription Drug Coverage

  • Covers most drugs, subject to a confusing array of co-payments and deductibles. 
  • Different from Parts A and B which you buy directly from Medicare, Part D you buy direct from private insurance companies and agents, if any. 
  • Like Parts A and B., you have an open enrollment for the same six-month period around your Medicare eligibility date during which you cannot be turned down for coverage for any preexisting health condition (i.e. Parkinson’s).
  • Entire books have been written about Part D. If you follow the following four guidelines, you will be able to maintain your sanity as you explore your options:
    1. Don't buy direct from an insurer without an agent.  Choose an insurance agent with expertise in the subject who can guide you through the choices and make recommendations to you. There’s usually no added cost to you to have an agent.
    2. Check with your pharmacist.  Many have computer programs that can tell you which of the many Part D plans available will cover all of the existing drugs you currently take. 
    3. Pick the plan the makes the most sense but don’t agonize over your decision.  Every year from November 15 through December 31, you will have another open enrollment period.  So if you at first choose poorly, you can make a different choice at the end of every year. 
    4. Test-drive the plan you like best.  See how well it covers your particular name brand and generic drugs.  If it doesn't meet your needs, change plans at the end of the year.  Usually, if you have Parkinson’s, your best option when leaving a job is to elect the COBRA option because you don’t have to qualify medically. However if you are married and your spouse has their own job and their own group health coverage, you generally have the right under the law, if you apply within 30 days of losing your group coverage, to be added to your spouse’s coverage with no exclusion for preexisting medical problems.

 
Important!  Even if you take no drugs when you’re first eligible and are the picture of health, opt for some basic plan that costs you little or nothing now. 

  • If you have a need for drugs later, you can upgrade your coverage on the next November 15. 
  • That way you will avoid a late enrollment penalty of 12% additional premium for each year you are eligible but don't take coverage.  (i.e. a delay of five years means five times 12% equals 60% more you will be paying for drug coverage for the rest of your life!) 
  • Note: you will not be penalized for delaying enrolling in Part D if you are still employed past age 65 and have group health insurance that includes prescription drug coverage as good as or better than Part D coverage. 
  • If you do, your group insurance company will notify you in writing that your coverage is “Credible”. The penalty won’t then apply to you.

 

Content for this section provided by Jack Hungelmann, who has had PD since 1996.

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