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Medicare Part D

It’s October – and the time of year when people 65 years of age and older have the opportunity to review their Medicare Part D plan. If you’re just reaching Medicare age, you might be surprised to find out that traditional Medicare doesn’t cover prescription drugs. As drug costs rose, Congress created a Medicare drug insurance program, called Medicare Part D, which went into effect in 2006.

To take advantage of this program, offered by private insurers, individuals receiving Medicare have to choose a drug plan every year, unless they have a Medicare Advantage plan that includes drug coverage or are covered through a former employer.

Plans vary by state, but most Americans have more than 25 plans to choose from, each offering different premiums, agreements with certain pharmacies and varying coverage amounts for the same drugs. This can make choosing the best plan a challenge.

Plans for 2020 will be revealed October 1 on the website, and participants have from October 15 to December 7 to choose a plan that will go into effect January 1, 2020. Even if you loved last year’s plan, it’s important you shop around from scratch this year.

To make sure you’re choosing the best Medicare Part D plan for you, start with the medications you take. On the website, you can enter your medications (including dosages and quantity) and the site will rank the plans by which would be cheapest for you, showing your medication costs on each plan and how much you’ll pay in premiums. You may need to search multiple times since the cost varies by pharmacy and you can compare only two pharmacies at a time.

Once you’ve narrowed your search to a few choices, you also want to check whether there are any restrictions on your medications. Certain plans, for example, may require prior authorization or step-up therapy, where you have to try and fail with one drug before the plan will approve another.

Those fortunate enough not to need any prescription medication may still want to sign up for a basic drug plan because Medicare charges a penalty if you don’t enroll when you’re first eligible. The penalty is based on how long you go without coverage.

Once you choose a plan, you can’t change it until the next open enrollment period unless you meet special circumstances, such as moving to an area where your plan is no longer offered or losing employer-based coverage. If you’re prescribed an expensive drug midyear, you’re stuck and can’t shop around for a new plan until the open enrollment period at the end of the year.

There are other opportunities within the State of Wisconsin when choosing a Medicare D plan. Have you heard of Senior Care or the State Health Insurance Assistance Programs?

YES, this process can be extremely challenging, especially if you are not Internet savvy. Help is available. The Medigap Helpline is a free, confidential counseling service for all Medicare beneficiaries, including disabled individuals and those age 65 and over. The insurance counselors at the Medigap Helpline can help you with questions about various health insurance topics:
• Medicare
• Medicaid
• Medicare Advantage Plans
• Guarantee Issue / Open Enrollment
• Medicare Prescription Drug Coverage (Part D) • Medicare State Health Insurance

Assistance Program (SHIP)
Medigap Helpline Telephone Counseling Service

Medigap Part D and
Prescription Drug Helpline
1-855-67PARTD (1-855-677-2783)

You can reach out to your local ADRC (Aging and Disability Resource Center) for additional assistance.

Kathleen Weston
Director of Hospice