Medicare Part D

Medicare Part D (Prescription Drug Coverage)

When choosing your Part D Coverage, it is important to make sure all of your medications will be covered by the plan.  Each plan will cover drugs differently, so a plan that is good for your spouse or neighbor may not be the best choice for you.

When to Enroll

To enroll into a Part D Plan, you must first be enrolled in Part A and/or Part B.  Your initial election period will be when you are first eligible for Medicare. The Initial Enrollment Period is the seven-month period surrounding your 65th birthday, starting the three months prior to your birthday.  You can make changes to a Part D plan during the Annual Election Period (AEP), which runs from October 15- December 7 each year.  There may be special enrollment periods (SEP) when certain circumstances arise.    If you are losing creditable coverage, you need to enroll in a Part D within 63 days.

Avoiding Penalties

Join a Medicare Prescription Drug Plan when you’re first eligible to avoid penalties.  At some point you will most likely need a drug plan. Not enrolling in a Part D plan on time will trigger a penalty. The late enrollment penalty will be added to your Medicare Part D monthly premium.  The national base Part D premium may increase each year, so your penalty amount may also increase each year. The penalty lasts as long as you receive Part D coverage. If you are losing creditable coverage, you have 63 days from your part B effective date to choose a part D plan before the penalty starts to accrue.

How to Shop for a Plan

If you are choosing a Medicare Supplement you will need an individual Part D plan. Many Medicare Advantage programs include Part D coverage.  When reviewing plans, get out your Drug list and use that as a guide. Match a plan with your prescribed Medications and preferred pharmacy for best cost savings. Use mail order services to maximize savings.  Shop for plans based on your individual needs and not your wife or neighbors. Plans are based on the area of coverage and the Drugs you are taking.

How to Save on costs.

Enroll in Part D within the first 63 days of eligibility to avoid penalty headaches later.

If you are in need of medications and without coverage or don’t want to have to deal with a prior authorization, or maybe you are hitting the donut hole, take a look at GoodRX for coupons on medications. Some medications may actually be cheaper when you use GoodRX over your Prescription plan. Navigating through formularies can be time consuming and they can change from time to time. It’s always best to review your coverage annually and make note of any new medications you are taking to be sure that they are covered by your Plan.

If you are without Part D plan and accruing a penalty, look into your State pharmaceutical Program ( SPAP) to see if you qualify. In some cases the SPAP program will pay off your late enrollment penalty. Qualifying is based on income, there is not an asset check.

In NJ, PAAD will help anyone with a medicare card if eligible with penalties and costs. To see eligibility requirements and apply click here. 

In PA, PACE and PACENET can help in the same manner with a partner plan, but only for those over 65. To see if you qualify for pace or pace net click here.

Check your particular State for these programs.

Brand name medications can be the most expensive, if not eligible for an SPAP program, try looking into Prescription assistance programs by the manufacturer of the medication. There is a company that will help you qualify for these programs if one is available. Have a look at Rx Assistance .

Lastly, if you don’t want to navigate through all this alone, feel free to fill out the form below for a benefit review where a Licensed pro can assist you with this.