The Value of Prescription Drug Benefits for Medicare Enrollees

By Rick Beavin, California Market President, Humana

If you currently have Medicare, or if you will soon become eligible for Medicare, prescription drug benefits should be an important part of your decision-making when it comes to choosing among various Medicare coverage options. 

 

It’s important to know that Original Medicare provides very little prescription drug coverage. Therefore, if you are eligible for Medicare and want drug coverage, you will need to purchase it from a private insurer, like Humana. You can either buy a stand-alone prescription drug plan—commonly referred to as a PDP—or obtain Part D prescription coverage through a Medicare Advantage plan that includes drug coverage.

 

Even if you’re not currently taking prescription medications, it is still a good idea to look into getting prescription drug coverage as soon as possible. One reason is that you may need to start taking a prescription medication sooner than you expect, but you can’t just sign up for coverage at any time. You can sign up for coverage only when you first become Medicare-eligible (typically at age 65) or during the Medicare Advantage and Prescription Drug Plan Annual Enrollment, which runs each year from Oct. 15 through Dec. 7, for coverage that starts on Jan. 1 of the following year. For example, if you are prescribed medication in July and don’t have drug coverage, you could have six months of paying for that new prescription out of your own pocket before your coverage kicks in on Jan. 1.

 

A second reason to enroll in Part D coverage as soon as you are eligible is to avoid an enrollment penalty. If you wait to sign up, the Centers for Medicare & Medicaid Services (CMS) can charge you a penalty every month, in addition to the plan’s monthly premiums. Penalties can range from a few dollars up to more than $20 each month on top of your premium. This can be a significant cost if you’re living on a fixed income. Once a penalty is assessed, it never goes away.

 

For these two reasons, it’s a good idea to sign up for drug coverage. The good news is that there are low-cost drug plans available. For example, there are Medicare Advantage plans that include drug coverage and have either a very low monthly premium or no monthly premium at all.

 

Fortunately, there are plenty of resources available to help you choose the drug coverage that is right for you. It’s always a good idea to find an insurance professional in your community who can help you look at the drugs you might want covered and how they match up with the prescription drug benefit of the various plans offered in your market. The government-run website Medicare.gov is also a great resource that allows you to compare all of the plans offered in your county and narrow down the options to the plan that will best meet your needs.

 

Even if you are already in a plan, the Medicare Advantage and Prescription Drug Plan Annual Enrollment Period (Oct. 15-Dec. 7) is the time to take a good look at all your plan options and find the coverage that is right for you. 

 

Rick Beavin is Humana’s market president in California.

 

Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on plan renewal.

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