Log in

Opinion

Medicare drug program seems confusing

Posted

I have received many calls regarding Medicare Part D for prescription drugs.

Part D has its own life and does not follow Medicare’s 80% medical coverage pattern for your health care. Let’s do an overview since it appears to be the most misunderstood part of Medicare.

1. You must have a primary residence in the country in which you enroll for a Part D plan.

2. You should enroll in Part D if you have a Medigap/supplement plan.

3. If you are enrolled in a Medicare Advantage plan, Part D is included. During this open enrollment period, which ends Monday, Dec. 7, you should check your plan to make sure your medications will be covered in 2021. Each plan has different medications and different preferred pharmacies. Be sure to purchase your needs from one of these pharmacies to pay the least amount.

4. If you have diabetes and are taking insulin, Medicare provides free testing supplies. Check with available MAPDs for special needs plans covering diabetics as well as discounts for insulin.

5. While checking out 2021 MAPDs, make sure your favorite doctors are in your 2021 plan.

6. Using your veterans benefits for your medications? That’s great. It’s also a good idea to enroll in a Medicare Advantage plan, with no premium, just in case your medication is not covered by VA. However, you must be enrolled in Part B. This is a great backup plan for medical needs, too. If you have TRICARE, most likely you have Part A, but you still need to enroll for Part B.

7. If you are single with a maximum total monthly gross income of $1,595 and resources of less than $13,110, you are eligible for extra help for your prescription drugs. You can enroll in a premium free drug plan and eliminate penalties if you enrolled in Part D late. Call for the numbers if you are married living with a spouse. The 2021 numbers have not yet been released.

8. Here are some little known facts about when your drugs are covered under Medicare Part B rather than Part D. If you take injections administered in the doctor’s office (drugs you would not administer yourself) it is considered medical under Part B. Examples are chemotherapy drugs, injectable osteoporosis drugs and those drugs used with durable medical equipment infused through a pump or nebulizer, as well as some end stage renal disease drugs.

9. Here is a thought to remember. If you have Medicaid (AHCCCS in Arizona) or receive estra help with your prescriptions, you are able to change your drug plan one time during each of the following periods: January-March, April-June, July-September. Otherwise, you are able to make a change only during open enrollment, Oct. 15-Dec. 7.

Call me at 623-866-4214 with any questions.

Editor’s Note: Roberta Ezratty is a certified State Health Insurance Assistance (SHIP) counselor.