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What About Part D for Medication?
 

We've covered the big pieces of Medicare and the supplements that fill in the major holes in traditional medicare.


There's one more piece!


Part D.


Medicare and the supplement plans do not cover prescriptions aside from might be administered in a hospital or facility setting.


As for outpatient RX (the kind you get from a pharmacy), there's no existing coverage in Medicare for that.


Based on that gap, they created Part D.


Let's do a deeper dive on Part D so you understand how to get the best value out of it.


These are topics to cover:



Let's get started!


What is Part D


Part D is a break-out part of Medicare that deals exclusively with medications.


It is separate from the other two main parts of Medicare:



Medicare loves its letters!


Part D is optional which means you can have to "opt-in" to receive it.


Read below to learn about the how's and when's with attention to the penalty for not enrolling.


Part D is the only way to get outpatient Rx covered with standard Medicare.


Part D is structured differently in that it's offered by private health insurance carriers, not Medicare itself.


Let's get into questions that come up frequently.


How to quote Part D


As certified Medicare supplements agents, we're happy to help with this process.


Just send us your medications and dosages to help@calhealth.net


We can send a secured email as well for this info.


With that, we can run a quote directly in Medicare's system to see what plans are priced best for your situation, including medication costs.


This generates a total out-of-pocket quote with both monthly premium and 


We'll send you over the three best-priced options with good reviews to compare.


The quote will reflect the lowest priced plus two more plans with richer benefits as a comparison.


What does Part D cover?


There was a set of rules established upfront with Part D benefits...a blueprint if you will.


The carriers can work around these requirements but they are general groupings of plan offering.

 

Here are the key considerations:



The deductible is really the big factor.  It can range from zero to a few hundred dollars.


This is the amount you have to pay before benefits kick in.


You then get a "menu" of copays depending on the type of drug (generic versus brand versus brand non-formulary which means...not on the "list").


These copays continue till a certain level where the "donut hole" kicks in.


This is a range where we absorb all the costs until the max is met and then the plan takes over again.


It's best to look at the quote and see how this actually settles out.


Another wrinkle is the list of drugs covered.


How to check my prescriptions for Part D quote


Even though the core benefits can be different, each carrier will have a different categorizing of various drugs.


One may say a drug is covered (brand formulary) while another does not (brand non-formulary or not covered at all).


This can have a big impact and it's why we need to submit your meds/dosages upfront with the quote.


The engine will literally take into account this info and work that information into the quote itself!


Very handy!


Again, email us for a secured email at help@calhealth.net and we can run the numbers for you.


How and when to enroll in Part D


There are two major windows during which most people enroll in Part D:



There are a few other less used rules so check with us regarding your situation.


Part D is unique also in that a person can enroll or changes plans at the end of each year during an open enrollment window.


This window generally goes from Oct 15 to Dec 7th of each year.


Enrollment is easy.


Once you've decided on the best plan from the quote we send over, let us know and we'll send the enrollment links ...either online or by phone.


This is all a free service we provide.


A similar question.


Can I change my Part D plan (and when?)


Yes!  This is really unique.


We can change our Part D plan at the end of each year regardless of health.


The new plan will go into effect on Jan 1st from a change during the open enrollment window.


This option actually figures into the next question.


Is there a penalty for not enrolling in Part D


There is a penalty for not enrolling when first eligible.


It's 1% per month for the duration after you were eligible.


For example, If you're eligible Jan 1st (say 65th  birthday is in January), and you wait till December to enroll (open enrollment window), you'll pay 12% (1% for 12 months each) more than if you would have enrolled back in Jan.


This can really add up (3 years = 36%) so a strategy is to get a placeholder plan.


A placeholder plan is basically the cheapest plan available (generally around $10-15) to avoid the penalty knowing that you can switch plans if RX kicks up at the end of each year.


Keep in mind that if RX costs go up mid-year, you'll be on the hook for that beyond what the cheapest plan covers but at least you have some catastrophic RX coverage.


Finally...the big question.


What is the best plan for Part D


We need to run the quote first fall with your medication list and favorite pharmacy factored in.


From there, we look at the total cost and the carrier ranking.


Keep in mind that the quote tool will take into account deductibles, copays, etc.


The combination of total expected cost and carrier ranking is our favorite tool to find the best Part D plan.


We're happy to run it for you at help@calhealth.net


It's a free service we provide to all our Medicare supplement clients.