Medicare Part D | Not Taking Medications? | Important Info About Medicare Part D Enrollment
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- Опубліковано 30 лип 2024
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Do you really need Medicare Part D if you're not taking any medications? Not necessarily. BUT, many folks don't realize that there is a Part D penalty that Medicare beneficiaries are subject to for every month that they go without credible Part D coverage. It’s called the Part D late enrollment penalty.
The late enrollment penalty amount typically is 1% of the Part D national base beneficiary premium for each full, uncovered month that the person didn’t have Part D or creditable coverage. Medicare, not the drug company determines the penalty. And Medicare bases this off of the average Part D premium for that year. The national base beneficiary premium for 2019 is $33.19. The monthly penalty is rounded to the nearest $0.10 and added to the monthly Part D premium.
So, let’s say in our example this person has been without credible Part D drug coverage for 30 months. 1% of $33.19 is $.33. $.33 x 30 months = $9.90. This person has now accumulated a $9.90 Part D late enrollment penalty, and a penalty is going to be tacked on to their Part D premium for the rest of the time they have a Part D plan. Let’s say they sign up for a Part D drug plan that is $20/month. The total premium will now be $29.90/month with the late enrollment penalty added on. The Part D penalty can change annually and Medicare determines the premium based off of the national base beneficiary premium for that year.
In general, if you have had a break in credible prescription drug coverage of 63 days or more after the end of your initial enrollment period for Medicare, you will face a Part D penalty.
Even if you are taking no medications you can always simply sign up for the least expensive Part D plan in your area to avoid the penalty. In many areas Part D drug plans begin at $10-$15/month.
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Don't you just love how the government forces you into buying something you don't need or penalizes you for not doing it? Ya gotta love the government.
Disgusting, corporations rule.
Wish I knew this information way before. Helping my grandma with her insurance and seeing the penalty return again this year, called her Insurance and they said as long as she gets Medicare she will pay the penalty, which I thought was insane, hung up, and searched online only to confirm the BARBARIC penalty. Sidenote: people's paycheck has a tax for medicare. They really be digging and getting their hands on money any way possible!!
This Lady "Stephanie" is the BEST ! completely satisfied with medicare "d" she recommended for us !!!!
NO "bs" ! straight shooter, no pressure !
Thank you so much John, I am grateful to have you as a client :)
Just outstanding information. Thank you very much!
You have addressed my long list of questions that others have not; thank you.
Very informative video Stephanie!! Thank you
Great informative videos! Thank you 👍
i am so glad i watched this👍🏼 A,B,D and N,,gotta update my choices🙏🏼
In our case (wife & myself) we have paid for Part D for 12 years and each year plans become more expensive, raise deductibles, and reduce the drugs they cover. In several years the insurance companies reduced or changed their formularies after one has signed up and after the ending date of the of the plan enrolment period...we're both duped and stuck.
This year I performed a analysis of costs with and without a Plan D at all...and we will pay considerably less with GoodRx compared to any of the 27 Plan D options available in our home area of Tampa. The most expensive drug I take is Lyrica. In a generic form my copay is $47 for a one month after I satisfy a $505 annual deductible. For the first 4+ months I am initially required to pay $150 for that month's Supply. With GoodRx I pay $32 for a 90 day supply with NO deductible to satisfy. On this basis we dropped our plan D coverage. I had to argue long and hard with Medicare to cancel however.
Since my wife & I take only drugs available in generic form we are able to save at least $2000 this year by cancelling plan our Plan D and using GoodRx exclusively.
I'm quite sure the math changes if one must take an expensive branded drug however don't count on a plan D plan to provide coverage either. One of the most popular branded drug is the blood thinner Eliquis which has no generic form. Not one of the plans available to me covered this drug which retails for over $450 per month and to compound matters neither does GoodRx or one of those discount cards that work only with a "commercially": available insurance plan (non government).
Medicare has a great online comparison tool that allows to to compare your estimated annual drug cost. Just type in you drug, dosage, and monthly usage and it will produce an estimated annual cost for every drug plan available. Then compare your costs to GoodRx and make an informed decision.
Love your videos! They are VERY helpful. Thank you!
You’re welcome! 😊
Thank you for making this information so clear and understandable. I've worried about all of this for so long now and you've unraveled it all and I'm so grateful.
That makes me so happy to hear! Please contact me directly with questions at any time.
Until I found your video I had no I idea. I had a low cost plan in the beginning but it didn’t ever cover anything - usually an antibiotic. ugh! Whstva drag. Why did I never know this. It certainly was never explained to me by anyone.
Stephanie is awesome! Clear, concise and direct. No time wasted with unnecessary words etc.
Thank you!
This info answered my potential questions
Thank you!
Please comment with your Part D questions below!
That "penalty" is ridiculous. When I joined Medicare, I was taking no drugs (still not) but I wasn't aware that Part D was "required". It wasn't made clear enough nine ears ago. So now until the end of time I'm going to be billed 3.60 . I really hate that. I'd like to opt out of Part D and get rid of that fine.
I agree, the penalty is silly. And many people aren't aware of it! You are not required to have Part D, so if you drop your drug coverage now then you won't pay the penalty any longer. However, if you then choose to get a Part D plan again in the future, the penalties will continue to accumulate.
All insurance is bought before the actual need.
Do the penalties increase if you drop Part D and then reinstate it at a later date?@@AbtInsuranceAgency
Say I delay signing up for a part D plan for 2 years. Assuming my plan is the average the national average of $33.19 a month. My penalty would be .33 x 24 = $7.92 a month when I did sign up. So the plan would be costing me an extra $95 a year than it would have it I had signed up right away. However, I would have already saved $796 over the 2 years of not paying the $33.19 premium. $796/$95. So it would take about 8.4 more years from the time I decided not to sign up, for me to get to the break even point out of pocket on part D costs. From then on, I would have to pay an extra $95 a year.
Or, you could do like I did. Just buy a bare bones, cheap part d to say that you did, and avoid paying a lifetime penalty. My plan is ten bucks a month. I lose more money than that in my seat cushions. Keeps me legal, but doesn't cost much, and has actually paid for a few prescriptions like eye drops when I got a splinter in my eye, or a cream when I got sunburn. Later, if I end up taking prescriptions on a regular basis, I can switch plans during open enrollment.
Stephanie has saved my wife and I a LOT of money with her expert advice. She provides clear complete explanations on the Medicare programs. Her videos are superb and to the point. We highly recommend her to all.
John Christian thank you John!
28 healthy young man here. I don't know how I came across your channel but I'm just gonna go into my backyard garden and throw dirt on me and pretend I'm a carrot
Thank you for the excellent video. Why do I want to have a professional relationship with a particular insurance agency (or independent broker?) Consideration for evaluating some?
why do you get penalized for not having party D ... shouldn't it be by choice to have it and not by force?
Notice that if you don’t know how to answer these filtering questions, you won’t see the lower cost part D plans first! Going on this Government website is like shopping on a car lot! All the best bargain vehicles are kept in the back of the lot!🤨
Great advice!
Brian Kalem thank you!
In my case, my prescription drugs are not covered by Medicare part D plans. So I generally use Goodrx discount program when purchasing my medications. The Medicare part D plans are not effective! I pay a monthly premium for something I cannot even use. The meds I take are common but for some reason Medicare doesn’t cover them, or coverage is at tier 3 or 4. It is a shame that our government allows insurance companies to offer drug plans that don’t cover drugs commonly prescribed to seniors. It’s utterly absurd. Who can I voice my complaint to about this?
Should I get on plan D now when the open enrollment begins? Which plan should I chose please?
Most likely the Humana Wal-Mart plan is one of the least expensive on the market, it's $13.20 for year 2020, avoid Wel-Care like the plague, when it comes to stand along PDP's that company is the most dysfunctional companies out there.
Very helpful video. For those subject to hefty IRMAA (but with few drug expenses), a future annual penalty of $47 for each year of delayed enrollment may be worth the risk of going naked, for a while, on drug coverage. The only caveat is the added risk of sudden unexpected out-of-pocket drug expenses incurred while uncovered, and the uncertainty of ELIGIBILITY to enroll in D later, particularly if a new "preexisting condition" arises in the interim with potentially substantial drug costs in the future. Can you speak to the risks and barriers to late enrollment (other than the penalty surcharge)? Is late initial enrollment in D (without exceptional circumstances) only available during the annual re-enrollment period? How austere is the scrutiny and evaluation of the health of the applicant when applying late? Would they require exclusions of preexisting conditions? Would the duration of the exclusion depend upon whether the condition could be chronic? Would coverage, with late enrollment, exclude chronic conditions that may be newly diagnosed during the initial months after (late) coverage is issued?
Thanks for your help.
I will turn 65 in October 2020. I will enroll in Medicare Part A pretty soon. (My 7 month enrollment period commended this month, July 01, 2020.) However, I am still working and have insurance coverage through my employer. If I wait until I actually retire from my job to enroll in Medicare Part B and Part D--at which time my insurance provided insurance will end--am I correct in thinking I will NOT be subject to the penalties for "late" enrollment, given that I had insurance through my employer? (I will elect for Part D--at some point--in case I eventually do develop medical problems that require I take medication regularly, though I do not now nor have in the past ever been on any medication regimen.)
I'm on Social Security Disability from a job injury. I'm only 63. But last year I switch to Humana advantage and I'm not sure if it covered Part D drug plan. Never needed prescriptions. I never signed up with for Part D I thought I would wait till I'm 65 I don't have any prescriptions. This year I switch back to original Medicare . But will I be penalized because I had Medicare Advantage that may have included Part D if I don't continue a Part D plan?
I worked in part D for two years as a CSR. I've seen people with penalties higher than their premium. Very sad.
It's a tyrannical rip off.
What is considered “ credible insurance “?
❤️❤️❤️❤️❤️
Does part d Medicare cover insulin and insulin pens?
At 4:20 when you share example and I have a tiny but important clarification question - in this example would the $9.90 penalty be due for the next annual cycle (lets call it year 3) but when the following annual sign up for year 4 in the annual enrollment I WOULD have creditable coverage so the penalty is actually effective for 12 months. Hope that makes sense. Am I wrong?
You will pay the penalty for as long as you have Part D. The amount is adjusted each year based on the average Part D national base beneficiary premium for that year.
I've heard the penalty is recalculated each year as the average national premium changes. Is that correct? That is, your penalty might be $9.90 per month this year, but more (or less) each year afterward.
Laughing Gravy that is correct. It is based off of the national base beneficiary premium for that year.
Stephanie I'm not taking any medications now but my doctor is thinking of putting me on a cholesterol med along with a blood pressure med. (if diet doesn't take care of it) I didn't sign up for Plan D early so have heard there's a penalty charge. However the penalty will be waived if you are with the VA which I am. Have you heard of this? I'm thinking I might want to do this if those medications are expensive. I don't know how. By the way I'm also on standard Medicare and have Plan N for a supplemental coverage at the moment.
You can apply for part D annually between Oct 15th and Dec 7th and you won’t face a penalty if you have VA coverage.
@@AbtInsuranceAgency Thank you very much for the reply. 🙂
Could one just forgo Part D and in the future if drugs are needed, just go to Mexico, India, or Canada for drugs as required?
I live in Illinois, I turned 69yo in March 2020, have had insurance through my wife's employer since 65. I want to switch to Medigap coverage this year. Will I have to pay a Part D penalty for the past 4 years?
Franklin Marshall not as long as your wife’s employer insurance is considered “creditable” Part D coverage. Typically employers have to notify you if the employer plan does NOT count as creditable for Part D, but you can double check with them to be sure. I hope this helps!
I just want to be sure I understand this correctly. Let's say I never ever want medicare part D. Does that mean my wonderful government can never impose that penalty? Personally, I think its criminal for any government to force its citizens to pay for drugs they don't want by imposing a penalty if they choose not to pollute their bodies with these toxic substances. I think our government should get out of big pharma's bed!
MasterBlogger1 Crucial Times Press if you decline Part D and never enroll in a stand alone Part D drug plan or a Medicare Advantage Plan that includes Part D drug coverage then you would never face a penalty.
My research is leading me to believe that plans beyond Part A and B are a scam on the American people.
@@masterblogger1crucialtimes838 I agree. In a few years on one of these plans I find I can easily get better drug prices online than I ever can through my “insurance” who I constantly have to haggle with. Clear Springs just raised my generic Rosuvstatin three month supply from $9 to $75 by changing the “tier” from 2 to 3. Surprise! Now I have to haggle with them to try and get an exception, and they have to write my doctor to see if he really wants me to have it) when their competitors have it as a tier 1 for $1. I can but it with GoodRx fro $10. And for this aggravation I get to pay $16.60 a month (x2 for wife as well who is on no meds). I’ve had it. Meds are pretty competitive now and I fail to see how me building skyscrapers for insurance companies is gonna make it cheaper that the free market. I’m gonna stop paying them, keep the money, and never get another Plan d. But if for some reason I need to, it will take them 8 years to get my savings back with their silly penalty. Jokes on them. I probably won’t live that long. So I win! Thanks for this vide that explains it so simply! You are a rock star!
But, it is always possible that five or ten years down the road you end up on some life saving drug that costs thousands of dollars a month. Never say never. It can happen to anyone. That's why I hedged my bet by buying the cheapest plan I could, even though I don't take any medications. It's like ten bucks a month. I can change during open enrollment later if I have to, but will avoid penalties.
How about if you're still working and you have health insurance and drug plan already do you still get penalized when you start
If your employer plan is considered "creditable" coverage for Part D then you would not get penalized as long as you enroll up to 63 days after you come off of your employer health plan!
Other than the monthly premium each month is there an enrollment fee also for part D
Mary Ward no, there is no enrollment fee for Part D.
If I change part D plans, I assume when enrolling in one, the old plan automatically cancels, correct?
Also, can I drop part D altogether if I want? Thanks.
W Baker yes, Medicare only allows you one Part D Plan at a time so the old Plan cancels when the new Plan goes into effect. And you can drop Part D if you’d like, it’s not a requirement. However, you will face a penalty in the future if you go without Part D coverage and then want to re enroll.
So your saying my initial enrollment period is when I’m turning 65 and since I didn’t enroll because of still working and having a credible a drug union plan, and since I’m retiring March 1, 2020, I have to wait until the annual enrollment period (Oct-Dec) to sign up. So I don’t get coverage until Jan 2021. If your saying I wasn’t eligible until March 1 of this year, then do I still get the 3 months after I’m eligible, the same as if I would have if signing up at 65.
You can delay Medicare if you're actively employed and have employer health benefits. This includes Part D. When you leave your employer plan and lose that coverage, you'll trigger a Special Enrollment Period in which you can enroll in Part D drug coverage.
Humana penalizing me because I didn't get prescription drugs, CAN YOU HELP ME?
What if you are on a Medicare Advantage plan that covers drugs , but a few years later you decide to switch to a Medigap plan ? If you're accepted, how would signing up for a drug plan work ? Would you have to pay the penalty ?
You would be able to sign up for a part D stand alone drug plan upon leaving your Medicare Advantage plan. As long as your Medicare Advantage plan included Part D Rx coverage (most do), you wouldn’t face any late enrollment penalties.
What if you did the opposite and went without part d converge for a couple of years then enrolled in a mapd with bundled part d coverage. Would you still pay a penalty on the mapd plan?
Why does GoodRx beat most insurance plans, on some drugs ( actually a lot of drugs ) even when you have to pay a premium to the insurance company , and GoodRx is a free service. There is something not right with insurance companies and the way they do business, what do you have to say about that Ms Stephanie ? I know you are just the Messenger, but this is just wrong.
I thought this was for people who don't take drugs.
You make me dizzy Ma'am is there a special Stephanie Abt history and bio appreciation website. i'm already going to work with you now i want to know more about you1!
Check out our website! HTTPS://www.abtinsuranceagency.com ☺️
So you mean to tell me that my husband is going to have to pay a penalty for the 10 years he has not had Part D ? Which means the penalty is going to be an extra $30 some odd a month?
If he is past age 65 and has not had other prior creditable drug coverage, then potentially yes.
@@abc68099 more information is found here - www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/part-d-late-enrollment-penalty
I’m on husbands health insurance, I’m on disability since 2006 im on part A but no B or D (drugs) how much will my penalties be? Husband is retiring 2023 Jan and I’ll get part B&D. I had tnbc cancer last year. Am I screwed? Pardon my French. Lol
Alice Lewis As long as your husband is employed actively and receiving employer health benefits (and you’re covered on his plan) and his employer has 20 + employees then you can delay Part B and Part D without penalty in most cases. When he retires you can apply with a “special election period”. You’ll want to make sure this employer health Plan is considered creditable coverage for Part D purposes. I hope this helps!
Abt Insurance Agency bless you and thank you so much! When he retires we will get in contact with you. 🌹
Do you work with folks in California?
Sheryl Siminoff yes, I do!
@@AbtInsuranceAgency I won't turn 65 until March 18th so when would I want to contact?
Sheryl Siminoff most of my clients start the shopping and enrollment process about 6 months prior to their Medicare eligibility date. But I can answer questions and help you sort through plan options whenever you are ready! Feel free to call me at (888) 465-9728 or email stephanie@abtinsuranceagency.com
Can I have both Plan D and advantage plan that has Plan d included?
Do you mean part D? Either way the answer is no. You cannot have a stand alone part D plan and a Medicare Advantage plan. One will always cancel out the other.
Thank you for your response. The reason I asked because I read a comment that he switch from using advantage care for 3 years to original Medicare and was penalized for not enrolled in a part D when he turned 65 back then. If I enroll in an advantage Plan for my first time in Medicare enrollment will the part D requirement be satisfied by the gov so I will not get penalized if I switch Medicare plan to supplement plans?
@@Rooster_Crows yes! That’s correct. You would not be penalized.
Meant to type 65 year olds”. NOT 65 yr old sons, sorry
who wrote these rule?...THE MARX BROTHERS ?
the penalty is nothing but another money grab.
It's outrageous.
@mariasimmons6098 what's more outrageous is the Biden administration is doing nothing about it.
Maybe this differs if you have Part B already but I just priced Part D plans on Medicare.gov for two generic meds, and the lowest was $31 a month, plus the med prices were hugely overinflated vs what they cost me using GoodRx (not my employer's plan). This is another example of out of control capitalism benefiting Big Pharma-not to mention that the price gouging is paid for by all of us.