Medicare Part D Enrollment

What Do I Need to Know About Medicare Part D Enrollment?

Medicare Part D enrollment sounds like a scary task. There are hundreds of plans to choose from and a lot of data to sort through. How do I choose one? When can I enroll? I will address all of the basics for you. This may not sound very interesting to a lot of my readers but remember this: if Medicare Part D enrollment doesn’t affect you, it definitely affects someone you care about. So, please read this for your parents, grandparents, or other family members who may need some help with this down the road. And I’ll promise to keep it light and as non-technical as possible.

Fall has finally arrived here in Texas. We have a high of 75 today (we hit 100 last week) and I am really enjoying sitting here with the windows open and writing a bit. With fall comes open enrollment for health insurance, including Medicare Part D enrollment. Here is what you need to know:

What is Medicare Part D?

To put it simply, this is the avenue by which you can receive prescription coverage through Medicare. Medicare Parts A & B do not cover medications. Because of the availability of these types of plans, most employers no longer offer any drug benefit after you retire. Medicare Part D plans are managed by outside companies which means there are lots of choices.

When can I sign up?

Ah…the most important part of signing up is to know when to sign up. Medicare Part D enrollment begins on October 15th and ends on December 7th. These dates are always the same and you should review your coverage at this time every year. You should not pick a plan and neglect to change it. Pick the best plan for you and re-evaluate it every year. Things change and it can cost you money if you aren’t paying attention. If you want to use Medicare for your prescriptions you must sign up when you turn 65 and are eligible. If you sign up later you may be charged a penalty that will be added to your monthly premium.

How do I sign up?

Signing up is actually quite easy. All you have to do is visit the Medicare website here to begin the process. You will need to enter your zip code and be sure to have a list of your current medications available when you sign up. You will be asked to enter all of your current medications and then you will be able to see a list of choices for providers.  The website is very interactive and easy to use. For best results, only enter the medications you use on a regular basis. Skip antibiotics or any temporary medications you might be using.

When you see your list of recommended plans, there is still a lot more information you can obtain with a few more clicks. The most important thing to know is that the recommended plans are based solely on what medications you are taking. It will show you the total expected out-of-pocket cost for the year, what your monthly premiums will be, deductibles, and what your expected copay will be for each medication you take. You can even see a month-to-month breakdown of expected costs and a prediction of when you should expect to enter the coverage gap or “donut hole”, what your costs will be while in the coverage gap, and when you should expect to be out of the donut hole. More on the donut hole later.

Play around with the plans and website. Change up your drug list. For example, replace a brand name drug that you take with a generic, or similar drug in the same class. See how that affects your costs. You might be surprised. You can also see prices at different pharmacies which will help you be able to stay at the pharmacy you like.

I am not good with computers. Is there any other way to sign up?

Yes, certainly. You can call 1-800-MEDICARE and an agent can help you sign up over the phone. Be sure to have your medication list ready so you can give it to them.

My spouse needs coverage too. Should we sign up for the same plan?

No. No. No. No. Is that clear? Do not sign up for the same Part D plan as your spouse. This might seem simpler but it could cost you. The recommended plans for you are tailored to your drug list. Your spouse has a different drug list. He or she should sign up for the best plan for them.

Can I pay someone to find a plan for me?

Yes, you can definitely find someone who is willing to take your money to do this for you. I believe it is a simple enough process that you would not need to hire anyone, but I wouldn’t blame you if you wanted to go that route. If you do decide to hire someone, I would recommend finding an independent agent. Someone who is not tied to any particular plan or company. If you hire a Humana agent then you can be assured you will end up with a Humana plan. Humana has great plans, but they may not be the best for you. Don’t limit yourself.

Why are we talking about donuts?

This part is making me hungry. Who doesn’t like a good donut? Medicare Part D patients, that’s who.

The coverage gap or “donut hole” is the most perplexing and frustrating part of Medicare Part D coverage. You can lessen this blow by preparing for it in advance.

The coverage gap was created so that patients and doctors would be be cognizant of medication costs, and as a result, help the government save money. The way it works is that your plan will track your spending throughout the year. Spending is defined as what they spend plus your costs, meaning the total cost of your medications (not just your copays). Once you + your plan have paid a total of $3,310 in the calendar year, you will enter the coverage gap. While in the gap your copays may increase dramatically. As I mentioned before, you can see (before you enroll) when your plan expects for you to go into the gap and when (or if) you will get out of it. This chart shows you how the prices are calculated while in the gap, and how that is expected to change in the future.

The coverage gap can be a real blow to the budget so be sure you prepare yourself. I see a lot of patients starting to go into the gap during the summer months, and a lot of them stay there until the year is over. The good news is that once you hit another spending limit you will emerge out of the gap into what is known as catastrophic coverage. At that point your copays will go down even lower than they were to start the year.

What are Star Ratings?

You will notice that each plan has a star rating. Star ratings are determined by a lot of factors. Some of the star rating is determined by patient feedback, but there is a lot more to it. We will talk in depth about star ratings in my next article. For now, I will just say star ratings are great but don’t let that be the only factor in choosing your plan. Cost should be your primary consideration.

I signed up but I don’t like my plan. Can I change?

Unfortunately, this does happen. The most common reason would be if your medication changed during the year and your new medication wasn’t covered well under your current plan. This possibility should always be considered when your doctor changes things. Be sure to ask your plan before deciding to add or switch medications.

The answer to the above question is no, but there is one exception. You may switch into a 5 star rated plan at any time during the calendar year. If there is not a 5 star plan that makes sense for you at the time, then you will have to wait until the following October to change to a new plan.

In conclusion, I want to remind you that Medicare Part D enrollment is an easy process. Don’t be intimidated. Be open minded about what company to use as a provider. Review every year to see if you can save some money.

If you have any questions or comments please leave them below.

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