Opinion

Ezratty: Medicare questions answered for enrollment

Posted 11/12/20

Question: I’m getting advertisements indicating this is the time to evaluate Medicare’s Part D drug coverage. How do I do this?

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Opinion

Ezratty: Medicare questions answered for enrollment

Posted

Question: I’m getting advertisements indicating this is the time to evaluate Medicare’s Part D drug coverage. How do I do this?

Answer: What a wonderful questions. I’ll bet most people are asking the same question.

First, it is important to know that Part D is different from Medicare parts A, B and C, which are administered by the federal government. Part D is provided only through private insurance companies that have contracts with the federal government and helps pay for your prescription drugs. If you are enrolled in Medicare’s Advantage Plan with drugs (MAPO) you do not have to enroll in a drug plan. Your prescription drug plan is part of your Advantahe Plan. In Maricopa County, all except Preferred Provider plans have a drug plan incorporated into their Advantage plans. When comparing your plan’s co-pay and perks, be sure your prescriptions are covered and what each prescription will cost you. Also determine which pharmacies are listed as “preferred” for your plan because your prescription cost may be higher in a non-preferred pharmacy. In 2021, you can expect to see an increase in deductibles; most insurance cokpanies are imposing a $445 deductible. During this open enrollment is the time to make sure you are enrolled in the plan best fitting your needs.

Medigap plans, also referred to as suplemental plans, do not have incorporated drug plans. You need a standalone Part D plan that has a monthly premium costing from $6.60 per month to more than $100 per month. This variance is based on the cost of the drugs you are taking. Even if you do not take any prescription drugs at the current time, it would be wise to enroll in a minimum payment plan when you are eligible to avoid a late payment penalty if joining in later years. Penalties are forever and increase with time. Expect to see an annual deductible of $445. Part D Prescription drug plans can only be changed during open enrollment between Oct. 15 and Dec. 7. However, Medicaid beneiciaries can change their drug plan throughout the year up to Sept. 30.

If you have limited income and resources, you may qualify for help to pay for drug coverage costs through the Extra Help program. For 2020, a single person with an annual income of less than $19,140 and resources of less than $13,110 is eligible for this program. They will find their cost of prescriptions significantly reduced. You can apply for Extra Help if you are enrolled in a Medicare Advantage Plan or a Medigap plan. If you have a Medigap plan, make sure you are enrolled in the current Part D plan in order to have plan premiums waived and drugs discounted. Please note, it is possible there may be an adjustment of eligible income in 2021. Apply for the Extra Help program through Social Security.

For more information, refer to your “Medicare and You” handbook or call Medicare’s SHIP counselor Roberta Ezratty at 623-866-4214 or SHIP’s hotline at 800-432-4040.

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

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