Community Chat

[winamac1]

https://www.ehealthmedicare.com/medicare-part-d-prescription/low-income-subsidy/?redirectFromHTTP

[Cats3000]

We make a list of our medications.  You can do that on the Medicare Part D website page.  We are on maintenance medications so we use mail order pharmacies.  We choose the plan that covers ALL of our medications at the lowest annual cost for mail order.  The only time we'll bypass that plan is if we've had problems with it in the past.

[Cats3000]

If you find it confusing, there are people in all localities that can help you through the process.  They are called "SHIP Counselors".  They sell nothing and have no axe to grind other than helping you find the plan that best suits your needs.  Look in your local phone book or try an on-line search for the SHIP Counselors in your area.

[Cats3000]

Yes, that is a problem.  The plans have a way to get you coverage.  You have to have your doctor write an appeal letter to the plan.

[kdgn]

If you are on an employer health plan when you reach the age of 65 the insurance company will send you a letter stating that the drug plan contained in your health care coverage qualifies as Part D. The letter also clearly states to keep that letter as proof of coverage. When you do sign up for either a Supplemental Plan plus Part D or an Advantage Plan that letter is your verification that you have received drug coverage and you will not be penalized for not having drug coverage. 

I received that letter from the two insurance companies that I was covered by when I turned 65. If I chose to stay on them I would have met Part D drug coverage-they were full policies. 

So if you continue to work past the age of 65, have full coverage through your employer's health plan that includes drug coverage, you will not be penalized if and when you do apply for Medicare coverage. Just keep those letters!

[Tenners]

KathyPet, I did a lot of research before I retired this year.  My first step was to contact my PCP and Cardiologist to find out what plans they accept.  Next I visited ehealthmedicare and entered my zip code.  I wanted an Advantage plan because It would cover my doctor visits and prescriptions.  A list of available plans for your zip code is displayed.  Review the plans that your doctors accept and compare.  Once I had a couple that I thought would work for me I discussed the pros and cons with one of their agents.  He was very patient and explained each plan.  I was fortunate that many years ago I worked in group health insurance so I understood the lingo and how insurance works, but their rep will explain it to you so you understand.  One thing you must do is confirm that your doctor accepts the plan so double check by using their doctor search tool.  The ehealth rep can help you with that too.  There is a tool for each plan where you enter your drugs to see if they are covered.  I found a great Advantage Plan with United Healthcare, a PPO, with a $0 monthly premium (you still need to pay the $126 Medicare Part B premium of course - there's no getting out of that) but there was no additional cost per month for signing up for the plan.  I pay $2 for most of my drugs.  One is a tier 3 and I pay $14 for that one.  I'll never hit the feared donut hole.  The ehealth rep and I set up a date and time to enroll over the phone.  Everything worked out just as I expected with no surprises.    My husband is thrilled that I know insurance and was able to find the right plan for us.  One of his drugs is $100 a month, but so what?  It's still way cheaper than my former employer's plan.  So get out a pencil and paper, go to the ehealthmedicare website and do your research based on your doctors and drug list.  The Medicare.gov website is very confusing and takes a lot of time to weed through all the information.  I really don't know how people with no insurance background do it unless they just drop it in an insurance agent's hands and hope for the best.  One more thing.  I had to prove I had creditable prescription drug and health insurance from my employer since I retired 2 years after I turned 66.  That means proof that my employer's plan was equal to or better than Medicare's plan.  I was able to get a letter and proof from my benefits manager before I retired, so I didn't have to pay the penalty of 1% for each month between my normal retirement date in 2014 and my actual retirement date in 2016.  I agree with one of the other responders here.  Avoiding the pitfalls of Medicare and Social Security ain't for sissies...it isn't easy for your average person who is used to buying what their employer offered and that's all there was to it.  I really hope this helps.

[Tinkrbl44]

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@sandraskates wrote:

@Joytoall Just want to say thank you for that simplified explanation. I've been on hubby's case to make sure he got some type of Part D coverage with his plan and he is covered.

This seems so convoluted and forced to me. Why should one have to pay a penalty for the rest of their life?!

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@sandraskates

If I had to guess, they must have decided that the law of large numbers theory would apply to prescription drug coverage for seniors.   None of us has a crystal ball, and no one knows what meds they will need next year ... or in 5 years.  

However, assuming that people sign up for coverage at retirement, and not wait until they think they might need prescription coverage will have a larger pool of coverage.   Some will use the drug coverage and others not so much, but it helps balance things out.  The "threat" of a penalty encourages participation ... JMO   

[Mmsfoxxie]

@kdgn, it didn't work that way for me.  When I became eligible for Medicare, I was told to sign up for Medicare but that I didn't have to pay into it until I retired since I had insurance on my job.  I was almost 68 when I retired and begin to pay the $104 and picked up a Part D plan.  Also my supplemental insurance.

[Moonchilde]

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@Mmsfoxxie wrote:

@kdgn, it didn't work that way for me.  When I became eligible for Medicare, I was told to sign up for Medicare but that I didn't have to pay into it until I retired since I had insurance on my job.  I was almost 68 when I retired and begin to pay the $104 and picked up a Part D plan.  Also my supplemental insurance.

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That's exactly how it was for me this past January. You have to sign up only for Part A at 65, but if you're working and have work-paid insurance after 65, you don't need to sign up for Part B, MA or a supplement, or Part D, until within 60 days after the date you quit/retire. I was not quite 67 at the time. I never got any letters.

When I applied with Medicare, at that time they (Medicare) asked for two things from my employer that I had to request from HR - my last day of work, and proof that between the age of 65 and my last day of work, I was covered by health insurance. These are forms the SSA office has or you can download and print from their ss dot gov website, which I did. That last form is to prove you did have RX coverage up until you quit.

[juperier]

@KathyPet There's a lot of great info in this thread. I wanted to add a couple of comments from my own experience earlier this year. Since you are on no meds, I would go with the cheapest Plan D based on basic cost and deductables. You can't really factor in prescription costs since you are taking no prescriptons. My understanding is that you need to re-evaluate each enrollment period. Drugs may be on different tiers with different companies and those tiers can change. Since ,you don't know which, if any, drugs you will require in the future, nor what tier they will be on at the time you need them, there just isn't a way to know what will be best in the future. But by purchasing a plan at least you will have some coverage and avoid the penalty.

Of course, this only applies if you are NOT switching to a Medical Advantage plan (Part C). MA plans often include prescription coverage. If you have prescription coverage under an MA plan, you cannot also be enrolled in Plan D.

Also, your Part D insurance does not have to be from the same company as your Medgap (Part F. ect.) plan. 

If you do decide to switch, make sure you follow the proper process during the open enrollment period. Otherwise, you have to wait until next year.