Medicare Part D is confusing to me. Why is that? What makes it so hard to understand? What is the donut hole? I thought it was going away. What’s wrong with picking the plan with the lowest premium . . . as long as it doesn’t have a deductible? And why do some plans have a deductible? How does it work? Do I pay the deductible BEFORE I have copay’s?
Can anyone explain how Medicare drug plans work?
GA Medicare expert Bob Vineyard can help.
Table of Contents
Why is Part D so Confusing?
Why is Medicare Part D so confusing. The Medicare drug coverage is designed by folks in Congress who will never use the plan. Part D is administered by insurance carriers.
What could possibly go wrong?
When you search for the phrase “Medicare Part D confusing” there are 107 million results. Congratulations! You are not the only one who is confused by Medicare drug plans.
What if I Can’t Afford My Drugs?
Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. If you have limited resources and income you may be able to get Extra Help. Monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.
To qualify for Extra Help you must meet the resources and income requirement. You must also live in the United States.
In some cases you might qualify for a PAP (Patient Assistance Program).
Yes, Medicare Part D is confusing but there is plenty of help. You just need to know who to ask. Consider the folks at Georgia Cares as an example.
Medicare Late Enrollment Penalties
Did you know you can be penalized for failure to enroll in a Medicare drug plan on a timely basis?
The late enrollment penalty is an amount added to your Medicare Part D monthly premium.
You may owe a late enrollment penalty if you lack creditable coverage for 63 days or more after your Initial Enrollment Period is over, you go without:
- Creditable drug coverage
- Medicare Part D plan
- Medicare Advantage plan that includes drug coverage
- Other coverage such as employer group health plan
Also the LEP depends on how long you went without creditable coverage.
Your penalty is determined by multiplying 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
The penalty you will pay is based on a formula so it could increase from year to year. It is also payable for life.
Medicare Part D is confusing. GA Medicare expert Bob Vineyard can help.
Part D Deductible
The majority of Medicare drug plans include a deductible. In most cases the deductible applies to tier 3 or higher drugs. The deductible can also be avoided by using mail order or filling your med’s at a preferred pharmacy.
Most people do not understand how the deductible works so they focus on plans without a deductible.
Many agents also do the same. Rather than explaining how a Part D deductible works they only sell plans without a deductible.
In most cases no deductible plans have higher premiums AND higher copay’s.
If you want to learn more about Medicare Part D plan deductibles, this video will help.
Why is Medicare Part D confusing? If it was easy you wouldn’t need me.