Good Shepherd Presbyterian Church

St. George, UT

 

Understanding Medicare Part D

On September 19th, we were privileged to have Gerene Mason as our Brown Bag speaker. Gerene, a representative from Southern Utah Insurance, is an expert in helping clients wade their ways through the Medicare Part D morass. As an agent, she represents various companies offering Part D plans, helps her client choose the one best suited to their needs, completes the enrollment and advocates for the individual throughout the year at no additional cost to the client because she is reimbursed by the chosen insurance company.

Her talk, ahead of this year's Part D Open Enrollment period from October 15th to December 7th, was both timely and informative. The Enrollment Period is your annual opportunity to enroll for the first time in a Part D plan, change from one plan to another or choose to keep the plan in which you are currently enrolled. The selection you make will take effect beginning January 1st of 2019 and extends for the calendar year. If you are enrolled in a Medicare Advantage plan, your drugs are covered under that plan and you do not need a separate Part D plan. Anyone covered under Original Medicare must subscribe, also, to a Part D plan for medications.

Additional Facts:

  • Four Phases to Medicare Part D in the calendar year are: paying a $415 deductible, if applicable, reaching a full drug cost of $3820 before entering the Coverage Gap(Donut Hole), being responsible for up to $5100 out of pocket before finally, entering the Catastrophic Coverage Phase with reduced coinsurance or co-pay for the duration of the year.
  • The Bipartisan Budget Act of 2018 will, over the next two years, close the donut hole so, by 2020, beneficiaries will be paying only 25% of their drug costs while in the donut hole.
  • When shopping for a Part D plan - check that your regular meds are covered by the plan's formulary(list of drugs covered), whether there are restrictions to any of your meds, and confirm that your pharmacy participates in the plan.
  • If you do not enroll in Part D coverage, if needed and when needed, you may incur a penalty for that failure which will be added to your costs, indefinitely.
  • In 2020, Medigap Plans C and F will be abolished but if you are already enrolled in one of the plans, you will be grandfathered and may keep the plan.
  • Financial assistance is available for securing your medications through the Medicare Part D Extra Help Program.

The entire Part D program can be an annual nightmare but there is help available.

You can listen to the audio of Gerene's presentation here. You can download a copy of Gerene's PowerPoint presentation here.

Additional help and programs for self-determination of a plan may be found on the government site Medicare.gov.