Medicare Health Plan or Medicare Part D Prescription Drug Plan?
Toni:
I am retiring January 1, 2017 and am beginning to search for the right Medicare option for me and my wife, who is having breast cancer treatment at MD Anderson. Her cancer treatment drugs are semi-expensive and I am concerned about the Medicare Part D out of pocket. I am a diabetic and using the flex pen with high blood pressure prescriptions. Most of mine are generic, except for the diabetic prescriptions.
Our Medicare Part B will begin January 1st as my company benefits will end December 31st of 2016. What should I do to prepare for this medical insurance change? I will be 70 and my wife is turning 65 by the time I retire and I want to be sure I do this correctly. Thanks, Dennis from a Katy reader.
Great question, Dennis:
The cornerstone of Medicare planning at the Toni Says office is prescription drug planning. The first topic discussed at a Medicare consultation is what Medicare Part D prescription drug plan or plans cover all of your prescriptions. Not all medications are covered under Medicare Part D plans.
Many are concerned about their doctor and completely miss if their prescriptions are covered under their new Medicare Part D or Medicare Advantage prescription drug plan. To their surprise, they must pay 100% out of pocket because their generics or even expensive brand name drugs are not covered.
Every Medicare Part D plan has a formulary whether it is a standalone or Medicare Advantage (Part C) prescription drug plan. If your drugs aren’t on that formulary, then you will pay 100% out of your pocket.
When we consult on Medicare at the Toni Says office, our motto is “Medicare is not cookie cutter…One size does not fit all!” Everyone’s Medicare health and prescription drug situation is different and your medical situation as well as your prescription drugs that you take should be considered in your Medicare needs calculation.
Those receiving Medicare Part B for the first time need to understand the value of the Medigap (Medicare Supplement) open enrollment. On page 102 of the 2016 Medicare and You handbook, it discusses “When to Buy” a Medicare Supplement. It states that “the best time to buy a Medigap (Medicare Supplement) policy is during the 6 month period which begins the first day of the month in which you’re 65 or older and enrolled in Medicare Part B”.
During this 6 month window one can enroll in any Medicare Supplement plan without having to answer any health questions and not be denied coverage. After the 6 month window, then medical underwriting takes place and one may not qualify for a Medicare Supplement.
At the Toni Says office, we treat receiving Part B like “gold” because of what it offers.
Many new Medicare beneficiaries explore the option of Medicare Advantage plans which is known as Medicare Part C. It is a good option and with health conditions such as you and your wife have, we advise that you speak with your doctor about what plans they accept or if that provider accepts Medicare Advantage plans.
To explore your options, visit www.tonisays.com and sign up for the Toni Says newsletter, download the 2016 Medicare costs and receive a free copy of the 2016 Medicare Prescription Drug Survival Guide e-book version.
Take your time and explore your Medicare health and Part D prescription drug options.
Toni King, author of the new Medicare Survival Guide®, which is a simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com. Email questions or to schedule a “Confused about Medicare and Social Workshop” for your organization or company lunch and learn to www.tonisays.com/ask-toni or call 832/519-TONI (8664).
