Frequently Asked Questions About Medicare
Q: Why is there a late fee?
A: Congress believes that unless you already have creditable prescription drug coverage, Part D plans are a great way for you to get help with the cost of prescription drugs. They crafted the rules to encourage people to enroll in the beginning instead of waiting to join only when health problems develop and drug costs rise. The late enrollment fee gives people a reason not to postpone the decision to join.
Q: Who is eligible for Medicare Part D prescription drug coverage?
A: All individuals with Medicare Part A and or Part B are eligible to enroll regardless of age, income, or health conditions.
Q: Do I have to participate in a Part D plan?
A: No, you do not have to participate in Part D. It is your choice. However, similar to other types of insurance, the longer you wait, the higher your premium will be. If you are eligible, and you do not sign up by the initial enrollment period, you will pay a 1% late enrollment fee each month you delay. You will pay this late fee for as long as you are in Part D. If you are late because you were participating in a qualified prescription drug plan, such as a plan from your former employer, the fees may not apply to you.
Q: How do I know if I should sign up now?
A: You will need to review your options carefully to see if a Part D plan is right for you. Part D plans are designed to provide financial savings to most people with Medicare. You may not feel that you need drug coverage now, however you need to remember that these plans will provide protection against future, unexpected costs. They also provide additional financial assistance for people with lower incomes.
Q: How do I find out if I qualify for help?
A: If you have both Medicare and Medicaid, you already qualify for low -income assistance. In some cases, the government will also review how many assets you own. If you think you might qualify, contact your local Social Security Administration office. You have nothing to lose by applying.
Social Security Administration: 1-800-772-1213
Q: What assets will be counted to determine if I am eligible for help?
A: The assets that will be counted include cash or any property that can be converted to cash within 20 days. This includes checking accounts, saving accounts, certificates of deposit, retirement accounts (like IRAs or 401(k)s), stocks, bonds, mutual fund shares, promissory notes, mortgages and life insurance policies. Property that is not counted includes your primary home, burial plots, or burial agreements. Certain funds set aside for burial expenses, up to $1,500, will also not be counted.
Q: Can I change Part D plans once I have enrolled?
A: Yes, you can change your Part D plan. The opportunities to switch are:
- Annual enrollment: Each year, you will be able to choose a different Part D prescription drug plan during an annual Open Enrollment period that lasts from October 15 through December 7. Coverage under the new plan will begin the following January 1.
- Other Exceptions: There are other limited exceptions that may give you the right to switch plans during a year. For example, if you move out of the service area of your current plan, you will have an opportunity to choose another plan that serves your new area.
Q: How will I know if the drugs I currently take will be covered?
A: Each Part D plan that is offered by the different companies will provide its own formulary or list of the covered drugs. This information is available through the plan’s Web site, customer service center, and through the marketing materials.
Q: Who decides which drugs will be covered on a formulary?
A: All Part D plans must meet formulary requirements set by Medicare. The formulary will include both generic and brand name drugs. Each plan must use a Pharmacy and Therapeutic Committee, which includes doctors and pharmacists, to establish its formulary. This will assure you that you will have access to a number of drugs, although not necessarily all drugs.
Q: What drugs are excluded from Part D plans?
A: Since the Part D insurer decides which drugs not to cover, this list cannot possibly be complete. However, Part D plans usually do not cover the following drugs:
The drugs that are excluded from Part D by Medicare are:
- Drugs used for anorexia, weight loss, or weight gain.
- Drugs used to promote fertility.
- Drugs used for the symptomatic relief of cough or colds.
- Drugs used for cosmetic purposes or hair growth.
- Prescription vitamins and mineral products.
- Non-prescription drugs.
- Inpatient drugs.
- Barbiturates
In addition, a drug cannot be covered under a Part D plan if payment for that drug is available under Part A or B of Medicare, such as drugs administered in a hospital or a physician’s office. Each Part D prescription drug plan may have its own specific exclusions.
Q: Will Part D cover drugs purchased from Canada?
A: No. Part D will cover only drugs sold in the United States.
Q: Can premiums be deducted from Social Security checks?
A: Yes, one can pay the Part D premium thru Social Security, coupon book, or Electronic Fund Transfer.
We are your local Medicare specialist. Contact Diana Wilson today at 636-391-3200 or email dianawilson@health1today.com.