Medicare Part D Update

Still not sure about the Medicare Part D basics?

• Who is eligible? - Anyone eligible for Medicare Part A or Medicare A&B can enroll in a Medicare Part D plan.
• Are there income requirements? - Medicare Part D plan enrollment is not based on income levels. However, Medicare beneficiaries who have financial limitations may receive "extra help" to assist with paying for their Medicare Part D plan. Medicaid recipients are automatically qualified for "extra help".
• You have low or no prescription drug needs - Should you enroll? - If you have only minimal current needs for prescription drugs, you still may want to consider enrolling in an inexpensive plan - if only to avoid a possible premium penalty and to ensure that you have prescription drug coverage should a need arise. Weigh the costs of an annual minimal plan premium against the potential costs of an increased Medicare Part D plan premium (due to the premium penalty that adds a 1% increase in monthly premiums for each month that you wait past the close of your Open Enrollment period).
• You currently have prescription drug coverage - Should you enroll? - If you already have "creditable coverage" and are satisfied with your provider, you may want to stay with your current plan. When your present prescription drug plan is considered "creditable coverage", no premium penalty will be assessed if you decide later to enroll in a Medicare Part D plan. Note: Most employer or union prescription drug plans are considered "creditable coverage".
• How to determine whether you currently have "creditable coverage"? - If you are not sure about whether your current prescription drug plan is considered "creditable coverage", review the information that you have received from the plan, look on the plan's Website or simply contact your Plan Administrator for further information.
• What is the difference between PDP and MA plans? - "PDP" is the acronym for stand-alone Prescription Drug Plans - plans that are focused on providing the Medicare Part D prescription drug programs and not an entire health care package. Whereas "MA" is the abbreviation for Medicare Advantage plans that are health services provided by a Medicare private health plan (for instance, an HMO or PPO). Medicare Advantage plans are sometimes known as Medicare Part C plans. Please note that in most cases you may not be enrolled in a Medicare Advantage plan with prescription drug coverage and a Medicare Part D PDP plan at the same time. If you are in a MA prescription drug plan and enroll in a Medicare Part D PDP, you probably will lose your MA prescription drug benefits. If you have questions, please contact your MA Plan Administrator before enrolling in a Medicare PDP. As reference, the Medicare Part D plans featured on our Websites www.Q1Medicare.com or www.Q1Insurance.com are limited to a selection of national PDPs.
• What plans cover my medications? - As noted in our last Newsletter, the Medicare.gov Website provides a "Formulary Finder" tool where you can search for plans based on your location and prescription drug needs. Some of our Newsletter readers noted that the Medicare system may be rather slow during peak usage times, so users may want to search for their medications early in the morning or later in the evening. Other sources have also advised that users of the Medicare system should double-check the accuracy of the Formulary searches against the chosen Medicare Part D plan's current formulary.
• What are the plan premium costs? - We provide a listing of selected plans on our Website:

Humana upgrades coverage of the basic 100 drugs

What is "Step Therapy"?

Scams and Prohibited Marketing Tactics

• No cash is needed. - The Medicare Part D program can be paid for in two ways: direct payment withdraw from your Social Security check (it is expected that most people will choose this method of payment) or a monthly bank draft (few people are expected to choose this payment method). No cash payment (including checks or money orders) is needed for initial enrollment in Medicare Part D programs.
• No Door-to-Door Sales / Limitations on Telephone Solicitation - Medicare Part D providers may not market door-to-door. Telephone solicitation is also restricted by CMS marketing guidelines.
• Feeling pressured? - Time is on your side and there is no reason to act spontaneous. Collect the information you need and discuss the programs with friends or family. Many communities have also set up volunteer hotlines to help with your decision process.
• Uncertain about the sales process? - Ask for the agent's credentials and company affiliation. Only deal with representatives of Medicare plans approved by CMS. As noted by some, it may be a good idea to invite a family member, social worker or a fellow church member to be present during the purchasing process. You may also want to ask for assistance from your insurance agent who may handle your other policies.

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