Medicare is an excellent program that helps our oldest and most vulnerable Americans get great quality healthcare.  As with all health insurance options in the United States, it isn’t always easy.  Prescription drug coverage for Medicare enrollees is often the most difficult piece to evaluate.  It can also have the biggest impact on your wallet as many prescriptions can be expensive if you do not have the correct plan.  Let’s take a look at the best ways to avoid penalties and save money on your drugs.

Minimize your Prescription Costs by Understanding the System

HealthyMarks Medicare is excellent at evaluating and enrolling our customers in the correct plan the first time.  Feel free to use this system below to your advantage.  Or give our team a call and ask us to help.

Drugs Not Covered by your Insurance Carrier

It is common for our clients to be using new and unique prescription drugs.  Some of these drugs are simply not covered and there are no alternatives.  Do not fret!  This is a common situation that can be resolved with a “Reconsideration Request Form” or a “Medicare Prescription Drug Appeals.”  Don’t resort to paying for the entire cost of an expensive drug.  Our team can help you through the appeals process to get that drug covered.

Understanding Drug Tiers and Preferred Pharmacies

Common drugs that have the same impact on your body can cost wildly different amounts.  The most common drugs are considered “generic” meaning you will pay only a small amount of money for that prescription.  However, sometimes doctors will write a prescription for a more expensive “preferred” drug.  It is up to you as the patient to determine if spending extra money on the preferred drug is worth it or if they’d rather ask for the generic instead.

Insurance carriers also change the cost of your drugs based on how you pick them up.  Insurance carriers use “Preferred Pharmacy” to deliver their prescriptions at a cost they can manage. So you may be encouraged to visit “CVS” or “RiteAid” for your prescription drugs instead of whatever is most local and convenient for you.  Many insurance carriers are moving towards “Mail Order” drugs so you can get a 3 month supply of your prescription sent directly to your door.

IRMAA Surcharges and the Appeals Process

For most people, Part B and Part D have a set monthly rate for all members.  So long as you’ve been paying your taxes for 10 years or more, you’ll have access to Medicare at the standard rate.  However, if you and your family are high income earners, you may be responsible for an additional cost for your prescription drug plan.

There are some options for you if you are categorized as a “high income earner” and you believe this isn’t accurate.  Sometimes there are life changing events that may impact your income for any given year.  For example, we had a client who sold their home and that additional income moved them into an IRMAA surcharge bracket.  We were able to connect with the Social Security Administration and explain the situation to remove the IRMAA charges.  Note that IRMAA is evaluated every year by looking at your past 2 taxes seasons.

Late Enrollment Penalties

There are many people who do not sign up for Medicare as soon as they turn 65.  You can postpone when you sign up for Medicare if you are working and have qualified coverage through your employer.  If your current health insurance coverage has prescription drug coverage, you can wait until you’ve retired before enrolling in your new Medicare Part D plan.

You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage . You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage.

As a rule of thumb, it is always best to consult a professional when it comes to evaluating your prescription drug options and Medicare options.  Our team goes above and beyond when evaluating plans for our customers.  We know that if we can get the plans correct the first time, we will have a happy customer for life.