medicare drug plan

Late fee

by AgentX86 - 2021-10-27 18:12:47

I wasn't aware that there was a late fee for Part-D coverage.  There certainly is for Part-B and if you're already in Medicare, companies selling Part-C (supplimental) plans can require underwriting after the Special Enrollment Period) but I wasn't aware that Part-D had any restrictions other than there is an annual enrollment period.

drug coverage

by new to pace.... - 2021-10-27 19:21:05

If you did not enroll in a drug plan when you were  first  eligible  for  Medicare.  You had to pay a late fee for  when you finally  enrolled in a  drug plan.  That is why i always took the lowest premuim one.  You can only change during the enrollment period Oct-Dec7th.

With Medicare(pays 80%)  of the approved amount. You should always get a Medigap  (supplement plan) which pays (20%)at the same time as regular medicare.  Or you are responible to pay that amount. 

I use Untied Healthcare( you do not have be a member of AARP,   as my suupplement.   Now they change their annual rate in July.  So you are now stuck..  Until the change period in the fall.  But it is hard to change, since you would be considered a new person.  And charged a higher preium.  They also change what is provided in the plan.

The US health care  system gets you coming and going.

new  to pace 

Medicare

by AgentX86 - 2021-10-27 21:48:24

I didn't know about the penalty for Part-D.  I knew about the Part-B penalty.  I'll be going on Medicare 1/1 but it's a special enrollment period for me (have been on a group policy).  I take a metric boaload of drugs so of course it matters to me. Eliquis, alone, has a retail price of ~$550. I'm on three drugs with a similar street price but, somehow, much lower formulary price for the policies I've been shown.

A previous employer kicks in some (retirement benefit) but I have to go through them to take advantage of it.  I submit the list of drugs and the pharmacy I prefer and the app spits back the options for each of us.  Choose the cheapest and we're off...

I will get a Part-C policy as well. Advantage plans are real come-ons - not happening.  I really don't know why anyone would take anything but Plan-G or perhaps Plan-N and gamble on co-pays.  They really aren't that expensive.  I was paying almost as much with an employer-sponsored policy (both of us w/drugs). 

The big deal with the suppliment plans is that you can go to any doctor/hospital in the country that accepts any medicare patients. That can be really important for many of us here.  Private insurance rarely offers this and Medicare Advantage plans don't.

Yes, the system is obviously designed by some government bureauracrat somewhere in the bowels of Washington.  It's confusing enough to have taken a whole army of them - deaf and blind ones.  The result really isn't that bad (exensive, comparitively) but the route between here and there is about as opaque as possible.

Medicare B, D Late Penalties

by Marybird - 2021-10-27 23:43:49

As New to Pace mentioned, the late penalties for these plans kicks in if a  person fails to enroll in the plans when he/ she is first eligible to do so, but enrolls at a later date. I think I saw the penalties were somewhere in the range of 1.5% a month over the premium, something like that.

The thing is, those penalties don't apply if you have "credible coverage" for the Part B or D with another insurer, even if you're eligible for these Medicare policies. So as long as you are still covered by another insurer with a policy equivalent to the coverage offered in Medicare Parts B, D, they don't count the time you haven't enrolled in those plans for penalties later on should you decide to drop that coverage and enroll in the Medicare plans. Because you had "credible coverage" during that time and there was no gap in coverage. 

It may be that your prescription drug coverage with your employer, should you be able to keep it after you retire, could provide that "credible coverage" so you might not need to enroll in a Part D medicare plan, and you wouldn't be penalized if you decide to enroll in a PartD plan later as long as you maintained your credible coverage till you got the Part D. 

Your employer should be able to tell you if your drug coverage is equivalent to the Part D plans, and can provide a letter documenting this credible coverage. We get such a letter every year from our secondary insurance, which covers our prescription drugs. 

Credible coverage

by AgentX86 - 2021-10-28 12:19:57

Yes, I just asked our HR for a letter of credible coverage.  I'm not sure it has to cover the last four years (since I turned 65)  but I assume HR knows all the details.  I asked the question anyway. 

Interesting, but the IRS needs that information every year, too, though it generally comes from the employer.  The two can't talk to each other, of course.

I get a bucket of dollars from a previous employer to use for Medicare.  I have to go through one of their approved plans and they manage it all but it's not an insignificant amount of money.

It Can't Hurt

by Marybird - 2021-10-28 14:43:31

Agent, we've gotten the credible coverage letter every year from our secondary insurance (FEPB), think it first came about with the advent of mandatory health insurance introduced under Obamacare. If I recall there was a form ( or line on a form submitted to the IRS at tax-time indicating the person's "credible insurance" coverage instead of an ACA marketplace plan. We filled out that info but far as I know we never sent the letters themselves tothe IRS.

At this point ( who knows about next year)  they aren't enforcing the health insurance coverage mandate, so there aren't any issues for not providing this info to the IRS. But our insurance company continues to send us the credible coverage letters yearly,  at this point we figure they could be used to document that coverage in the event we switch to a Part D medicareplan. This is very unlikely to happen as we 're happy with the coverage our insurance provides, but those letters do provide proof of your credible coverage.

Sounds as though you could be well set if you choose to use the Medicare coverage your previous employer has kinda pointed you to with those dollars they've sent your way. Guess it's a choice of whether or not you like or can live with those plan over time. I think my brother has a similar situation, his is from the teacher's union in NYC, and some of our friends here also get their Medicare coverage ( generally Part C Advantage plans) through their former employers. Haven't heard anyone complain too much! 

Medicare coverage

by AgentX86 - 2021-10-28 18:02:01

What it really comes down to is that PPOE wants to act as the agent.  They have a pot of cash that I can use to offset some of the costs, whether it be an (dis-) Advantage plan or suppliment. It's likey a tax thing.  As long as I don't touch the cash it's deductible for them and I'm not taxed either (much like employer sponsored insurance).  The insurance plans they've selected have to be doing business in my county (I think but this situation may be out in the Medicare weeds, legaly).  It's a pretty sweet deal, really.  I haven't worked there for fifteen years and have been drawing a pension since, now they'll pay about 1/3rd of my medical costs.  ;-)

I have no interest in an advantage plan.  There are too many restrictions and they can get really expensive if things go wrong, which they have for me a couple of times. Unless one just can't afford (I don't mean that they don't want to pay for) a suppliment plan, it's crazy to go any other way.

Medicare

by ROBO Pop - 2021-10-28 20:18:57

You guys are over simplifying Medicare and in fact there are variations in coverage and costs just dependent on where you live. Example I have Medigap part F and can never change to another carrier as they do not have to accept you after the intial enrollment period. Arizona is one state thst allows insurers to refuse enrollment for any reason after that initial period so... 

What I'm trying to say is contact a licensed insurance agent who handles Medicare and work with them to find the policy that best suits your needs. They cannot charge you for the service. 

Simple

by AgentX86 - 2021-10-29 15:15:48

There is no such thing as under-simplifying Medicare but, sure, we haven't explicitly stated all of the nuances but at least touched on everything you've said. My POPE'S agent is exactly that. I've alluded to the county by county differences and, no, ALL Medigap plans are the same no matter where you live. Rates may vary but a Plan-F for me has EXACTLY the same coverage as your Plan-F.

Yes, it can be difficult to impossible to change plans or Advantage to Medigap once you're in. That's why it's stupid not to go directly to the best plan during the SEP.

You can change to another carrier if they end coverage in your area or you move to an area where they don't cover.

Yes, it's complicated and, no, we didn't discuss all of the rules. Even with an agent one has to know the basics and really understand all of the pitfalls. SEP enrollment is critical. Not so much after.