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Medicare Part D Questions and Answers

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By Rev. Geoff Hubbard
Chairman, Board of Directors
Bedford Parish Nurse Ministry

    What is Medicare Part D? Medicare Part D is an addition to Medicare that helps seniors with the cost of their prescription drugs. Medicare Part A (hospitalization) and Medicare Part B (visits to the doctor) are both government run. However Medicare Part D is run by private insurance companies. Many companies offer different plans and it is up to each person to find the plan that offers the best coverage for their particular medical needs.
    Should I wait until I sign up for Social Security to enroll? No. The eligibility age for Social Security is rising. In 2012 it is 66 for most retirees. However the age at which you must enroll in Medicare has not changed and remains 65. At that age you must enroll in Medicare including Part D.
    Why should I sign up for a Medicare Part D plan? I don’t take any prescription drugs. Its the law. All seniors must sign up for Medicare Part D coverage for the year in which they turn 65. Anyone who enrolls later will be penalized by increased premiums and co pays on their medications. These increases will be 1 percent each month until you do enroll. So, for example, if you are 65 and you wait until next year to enroll you will be paying an additional 12 percent on your premiums and co pays no matter which plan you chose. And that increase will continue for the rest of your life.
    What if I have prescription drug coverage through my employer or former employer. Do I still have to enroll? That’s the exception. If as an employee or a retiree you have prescription drug coverage that is as good or better than Medicare Part D you do not have to enroll as long as you have the coverage. To know that your current drug plan has been evaluated as being as good or better than Medicare Part D your employer is required by law to send you annually a Creditable Coverage letter. If you have this letter you may enroll in Medicare Part D within 63 days of when this coverage ends at no penalty. However if your employer has not sent you a Creditable Coverage letter than you would still need to enroll. If you have any questions about whether you have Creditable Coverage ask your employer to send you notice in writing.
    Why is there a ‘doughnut hole’  in Part D coverage? It’s not fair that there is a period in which I still have to pay premiums but get no help with my drug costs.
    With most insurance the premiums paid by young, healthy subscribers are used to pay the medical expenses for those who need them. However Medicare Part D was set up to help pay the drug costs for people 65 and older. At this age most people take more medications than they did when they were younger. In order to keep the plans solvent they were set up to include an initial period of coverage in which the plan pays at least 80 percent of prescription costs. The plans were set up with the estimate that 80 percent of seniors would be covered by this initial period without going into the gap. After initial coverage the subscriber goes through the gap or doughnut hole during which they get no coverage but continue to pay premiums. It is these premiums that pay the costs everyone saves on medications. At the end of the gap those who still have prescription drug costs will be in catastrophic coverage during which at least 95 percent of their drug costs are paid until the end of the year.
    Once I enroll in a plan does it matter which pharmacy I go to? YES! Some plans partner with pharmacy chains like Walmart or CVS. In these plans you must go their partner pharmacies in order to get the best coverage. This can be a difference of several hundred dollars over a year. The person who helps you enroll should give you this information. If not, when you get your 2013 drug card go to both CVS and Walmart and ask the pharmacist if they are partners with this plan. Ask what the cost will be for your prescriptions over a year at both places and see if you will save at one place or the other.
    Is Medicare Part D going to be repealed next year depending on who wins the election? Not that I am aware of. Medicare Part D has been around since 2006 and is not part of the Affordable Health Care Act (“Obamacare”). And what someone says when they run for office is not always what they do when they take office. All any of us can do is make the best choice we can based on the information we have now and see where we are in 2013.
    I have a good plan now. Why should I consider changing? Two reasons: Your prescription needs may change and the plan itself may have changed in what it will pay next year. Everyone should review their drug coverage annually.
    How can I decide among the many plans available? By going to a health insurance expert you know and trust. This person should be someone local who will be here to help if problems arise. A salesman in a mall or department store is only there during open enrollment and usually sells only one plan. People who call or knock on the door to solicit you for a plan they sell are often only after their commission and could care less about your health needs. If you wouldn’t buy a used car from someone you don’t know, don’t buy a drug plan from them either.
    There is free help available from trained people who are local and don’t get a commission from any plan. These people will take your prescription information and run it through the Medicare website. They will then show you the results and enroll you in any plan you choose. In Lynchburg and Campbell County contact the Central Virginia Area on Aging. In Bedford City or County please call Pam Willoughby at the Bedford Parish Nurse Ministry Thursdays or Fridays at 540-875-8655. These groups will be happy to help.