You Need Medicare Part D For These Critical Reasons

By: Meredith Miller
Published: Tuesday, February 26 2019
Last Updated: 3 years ago

If you’re unfamiliar with Medicare Part D, it refers to the stand-alone prescription drug plan offered by private insurance providers. While Medicare’s drug plan will cover most of your self administered prescriptions, any medication you receive as an inpatient will be covered under Medicare Part B.

Many Medicare beneficiaries choose to take advantage of Part D plans to help offset their out-of-pocket costs, but there are still some who are on the fence about adding additional premiums to their already fixed budget. If you are one of those people asking yourself, do I need Medicare Part D, here’s what you need to know.

Are You Required To Enroll In Medicare Part D?

Enrollment in Medicare Part D plans is completely optional, as is the case with any insurance plan that requires you to pay a premium to receive benefits. While Medicare Part D is not mandatory, it is still a good idea to opt for prescription drug coverage early on in order to avoid any potential late enrollment penalties, and protect yourself from any costs you may endure in the future.

Why It’s Still a Good Idea Even If You Don’t Take Medication

Medicare Part D is a cost-effective way of obtaining prescription drugs through either a Medicare Prescription Drug plan or Medicare Advantage prescription drug plan. In the latter case, the plan combines Medicare Part A and Part B benefits with coverage for prescription drugs.

Medicare prescription drug plans are administered by private insurance companies, and hence the prices are competitive in nature. Having Medicare Part D benefits as a part of Original Medicare from the start will save you from paying penalty as well.

Do You Need Drug Coverage If You Have An Advantage Plan?

Most Medicare Advantage plans come with prescription drug coverage by default. Hence, there is no need to enroll in a separate drug plan. In fact, Medicare Advantage Plan, also known as MA plans or Part C, is an all-in-one alternative for Medicare Part A and Part B. This plan is offered by private insurance companies that are approved by federal government.

If you are enrolled in Medicare, you can still join a Medicare Advantage plan. However, you will be removed from this plan and returned to Original Medicare plan if you enroll in a separate unauthorized Medicare Prescription Drug plan or are enrolled in a Medicare Advantage PPO or HMO.

What About If You Have A Supplement Plan?

If you are enrolled in a Medicare Supplement plan, also known as Medigap policy or Medicare Supplement insurance, you will need a plan that covers prescription drugs. However, you can still avail the benefits of Medicare Part D with Medigap plans. Medigap policies are no longer sold with prescription benefits. With the previous enrollment in Medigap policies, you can keep your policy’s drug coverage but not have Medicare Part D benefits at the same time.

Non-creditable Medigap policies do not offer adequate coverage, so you will have to pay penalty for choosing Medicare Part D at a later date. Note that, you can keep your policy without drug coverage or switch to another Medigap policy with no drug coverage and enroll in Medicare Part D plan to cover prescription drugs. Here, you have the opportunity to lower your monthly premium. In essence, you can have Medicare Part D with Medigap plans.

Can You Delay Enrollment?

Yes, you can delay enrolling in Medicare Part D. Although, you will have to pay a late enrollment penalty, which is the amount added to your monthly Medicare Part D premium. This penalty is owed for not having Medicare Part D for any continuous period of 63 days or more after the enrollment period. In essence, you will pay penalty for not having any one of these plans for more than two months period:

  • Medicare Part D or Medicare Prescription Drug plan
  • Medicare Part C or Medicare Advantage plan – HMO or PPO
  • Creditable prescription drug plans
  • Any other Medicare plan that offers prescription drug coverage

The Late Enrollment Penalty

The late enrollment penalty is the amount you will pay for not having Medicare Part D or prescription drug coverage from a creditable plan. This amount is calculated by multiplying 1% of the national base beneficiary premium to the number of months that are uncovered by the above mentioned plan. The amount is then added to your monthly Part D premium. For 2019, national base beneficiary amount is $33.19 and may increase every year.

What If You Get Drug Coverage Through Medicaid?

It is possible to enroll in Medicaid and Medicare Part D at the same time. Drugs that are excluded in Medicare coverage can be covered through your state’s Medicaid program. Some of these drugs include, but not limited to:

  • Drugs for fertility
  • Drugs for weight loss and weight gain
  • Drugs for Cosmetic procedure like hair growth
  • Drugs for symptoms relief such as cough, cold and stuffy nose
  • A few over the counter drugs
  • Prescribed vitamins and minerals

A small co-payment may be required for prescription drugs that are covered by Medicaid. Each state has its own Medicaid formula for calculating the cost of co-payment.