10-12-2022 PTL - Flipbook - Page 24
24 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, October 12, 2022
MEDICARE PART D
Making Part D
work for you
Don’t underestimate
the benefits
By Margit B. Weisgal, Contributing Writer
T
he annual open enrollment period for Part D, the section of Medicare that concerns
your medications, runs from October 15 to December 7 each year.
For first-time Medicare enrollees, there
is an open enrollment period in which you
may choose a drug plan. It starts three
months before your 65th birthday, your
birthday month, and three months after.
(Also, for those people who qualify for
Medicare under the age of 65 due to disability, the seven-month enrollment period
is based on the Medicare Part A effective
date.) And you should get Part D. See
the cautionary tales below. After that, you
should reevaluate your Part D plan every
year during open enrollment so that you
get the best value for your money. If you
have a Medicare Advantage Plan, many
include drug coverage, there is also an
open enrollment period that coincides
with the one for Part D. Carefully read
your Statement of Benefits and Coverage
(SBC) to make sure you’re protected.
True story: Prior to turning 65, Kelly
Ortega’s costs for her two generic medications ran about $20 for a 90-day supply, so when it came time to sign up for
a Part D plan, she didn’t. “Why should
I spend another $15 or so each month,
$180 a year, when my total drug costs
were $80 for a year.” When she finally did
sign up for a Part D plan, she found out
there was a penalty amount added to her
premium every month for as long as she
will be enrolled. Penny wise, dollar foolish.
The moral of this story: sign up immediately when you turn 65, or when you first
become eligible for Medicare. You don’t
know what the future holds, but it’s better
to be prepared. And who wants to pay
extra as long as you have a Part D plan?
Another true story: Shawna Edwards
got a low-cost Part D plan. Due to a
medical problem, she needed a prescription medication that would cost her $350
three or four times a year through her
plan. She was horrified. A friend told
her to ask her plan’s management for
an exception. She contacted the insurer,
and it agreed to lower the cost. And it
did – to $6. Sometimes it’s worth asking
for assistance.
And one more: For Luis Asano’s Part
D plan, his pills were reasonably priced,
but there was a catch. He had a $480
deductible. Needless to say, he was a
little upset that he was paying high prices
for his meds in order to reach his deductible. A friend suggested he pick up a
Good RX card. He went to the website,
www.goodrx.com, and compared prices
of pharmacies close to him. Huge difference. Instead of paying over $50 for one
drug he was on, it cost him $15. Another
medication that ran $187 was now $48.
Sometimes you need a work-around.
How Part D Works
All Part D plans work the same: A
monthly premium and your copay that
you pay at the counter when you pick
up the prescription. Each company sets
up different tiers for each medication in
their formulary, the list of all medications
they offer. Those meds that are the least
expensive will appear on tiers one and
two. Different Part D plans have different
formularies. So, a drug that’s tier one on
one plan may be tier two on another. You
want to get your drugs for lowest cost so
shop plans.
Why should you reevaluate your Part
D plan every year? It’s simple. Each year,
companies that offer Part D plans modify
their Plan costs and their formularies. They
also modify into which tier each drug falls.
One year your costs may be less with
Plan A, the next year it may be Plan B.
It’s worth checking out. You may end up
with the same Plan but, again, it’s worth
making sure.
When you choose a policy, look at
what your total out-of-pocket costs are
expected to be based on your current
prescription drug utilization. It was part of
the problem Luis Asano ran into.
There are brokers who specialize in
health insurance for people on Medicare.
Many of them will compare Part D plans
as a courtesy. There are also websites
that will help with making the comparisons
including one that’s part of Medicare:
www.benefits.gov/benefit/2202. Part D
plans will have the pricing for the individual medications available before the
open enrollment period so you can see
what is available.