Medicare Open Enrollment (Part 3 of 3)

In the first part of this three-part series on the Medicare open enrollment period that ends on December 7, we learned that Medicare Parts A and B, also known as original Medicare, provide no benefits for prescription medications.  We also learned that Part C, which is optional and available through private insurers, sometimes includes a prescription drug benefit.  But we also learned that Part C is not a viable option for most of us in the Allegheny Highlands due to requirement that beneficiaries join a preferred provider or health maintenance organization, whose healthcare providers may be difficult to access.

This is where Medicare Part D comes in.  Like Part C and Medigap insurance, Part D is provided through private insurance companies.  Its sole purpose is to help Medicare recipients pay for some of their prescription drug expenses.

It is important to know that failure to be enrolled in Part D for any period of 63 consecutive days or more will result in a permanent penalty if you decide to enroll in Part D at a later date.  The penalty is calculated at 1% of the national base monthly premium.  For 2020, Medicare has calculated the national base monthly premium to be $32.74.  So, for every month during which you are not enrolled, a penalty of approximately 33 cents will be added as a penalty to your Part D monthly premium if you decide to enroll at a later date.  That may not seem like much, but someone who defers coverage for two years is looking at a penalty of $7.86 added to each future monthly premium.

The official Medicare website has a nifty feature that allows a person to compare costs of Part D plans.  The user merely adds his or her current medications and dosages and the pharmacy or pharmacies at which the insured would like to have prescriptions filled.  There is also an option to have medications filled by mail order.

Once the required information is entered, available Part D plans will be displayed and they can be sorted either by the cost of the monthly premium or the total annual cost of insurance plus medication.

As an example, I entered generic 40mg atorvastatin tablets, which is a common cholesterol drug, and generic 40 mg propanalol tablets, which is a common beta-blocker used mainly for heart conditions.  I selected three pharmacies – one in Monterey, another in Hot Springs and a third in Staunton.  The monthly premium for the least expensive plan was $22.20 per month.  The cost of the drugs, however, varied by pharmacy.  Two of the three pharmacies were designated as preferred, in-network pharmacies and each of those two would charge $2.00 per month total to fill my monthly prescription.   The third pharmacy, which is designated as a standard in-network provider, would charge $14.20 to fill my prescription each month.  The conclusion is that there can be a significant difference in drug costs between pharmacies.  If I were to use the least expensive of the three pharmacies under this plan, the monthly cost of insurance premium plus medication would be $24.20.

But, here is an interesting quirk.  The standard retail cost of the generic drugs I used in this example are only $4.63 at the least expensive of the three pharmacies.  I might choose to forgo enrollment in a Part D insurance plan since I can save almost $20 per month by just paying retail.  On the other hand, I may need additional prescription medications in the future and the longer I defer coverage, the greater my monthly penalty will be.

So, what’s a fella to do?  That’s the very nature of insurance.  We pay for it hoping we’ll never need to use it.  We pay for insurance on our cars and we hope to never have an accident.  We pay for insurance on our homes and we hope to never suffer a house fire. We don’t enjoy paying the premiums, yet insurance can bring us peace of mind.  Only you can decide if enrolling in a Part D insurance plan is right for you or if incurring the monthly penalty is a better choice.

A link to the Medicare Part D comparison feature is included on our web site at the conclusion of this story.  This is Mickey Frank Thomas for Allegheny Mountain Radio.

Here is the link to the federal government’s page to investigate and compare Part D prescription medication plans:  https://www.medicare.gov/plan-compare/#/?lang=en

Below are the names and contact information for the Medicare counselors in each of the three counties served by Allegheny Mountain Radio:

Ashley Hutchinson (Bath and Highland Counties)

Virginia Counseling & Assistance Program

(540) 468-2656

Lorrie Batton (Bath County)

Bath Community Hospital

(540) 839-7188

Rebecca Bivens (Pocahontas County)

West Virginia Disability Network

(304) 425-2040