Medicare Part D
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 12/21/21
Duration: 10 Minutes
In this episode, Ben Rothering gives us information about Medicare Part D. Mr. Rothering talks about choosing a Part D that meets your needs, what it covers, who offers it, the enrollment period, and penalties.
Transcription:
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part five of our five-part series on Medicare. For anybody who is eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D is Ben Rothering. He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. So Ben, welcome back to the podcast. We're in our last episode, in this five-part Medicare series that has been really educational and really answered a lot of questions for me. And I'm sure for listeners as well. We talked way back in episode one about enrollment and dates and particulars. We've covered parts A, B and C, and today drum roll please, today, Ben is going to talk part D. So I'll let you do that.
Ben Rothering BS Education (Guest): So part D is all about prescription drug coverage, so D for drugs, right? So a drug plan is something that you are definitely going to want to have. Whether you take prescription medications or not, enrolling in a drug plan is voluntary. However, if you enroll outside of your enrollment period, into a drug plan, there's potential that you would end up getting a penalty for that late enrollment. And the penalty is 1% per month, on top of your base premium for the rest of your life, as long as you have Medicare.
So even if you take zero prescription meds at this time, it's still an important thing to have to make sure you don't get a penalty down the road. There are several different drug plans that are offered. In different states, and it can vary, every single year. These prescription drug options are run by private insurance companies that are approved and under contract with Medicare and a prescription drug plan is going to help cover the cost of prescription drugs only. So brand names or generic meds. It Is not going to help with anything that is over the counter, vitamins or anything like that.
And the hope is that it's going to help lower your prescription drug costs and help protect against some of the higher costs in the future. I can't stress enough how important it is to review your drug plan every single year, during open enrollment from October 15th to December 7th. This is an opportunity for everyone who is on Medicare and has a drug plan to take a look at the plan that they currently have and see any of the changes that were made. And there are a lot of variables that go in to the changes that are being made and how that could affect your pocketbook. So again, I can't stress enough how important that is to really take advantage of that timeframe because all of these variables, whether it's the premiums of every drug plan or the deductibles or the way that every individual drug plan covers your meds, you know, all of those things can change. Your own individual med list can change as well. So, it's very important to take a look at these things and all of these different plans that are being offered, they don't have to cover your meds the same and it can change from year to year.
So you could literally take your med list and look at, you know, prescription plan A, B and C, and A B and C could cover one of your meds totally different. One could cover it as a tier one preferred generic med and maybe they give it to you for free or have a really, really low copay, plan B could cover that same med as a tier two generic med. And now maybe you have a little bit of a higher copay and, you know, plan C could cover it as a preferred brand name. So maybe now you're paying out of pocket until you meet your deductible. And all of that can change from year to year. I know in my experience, with talking with my clients and helping review their drug plans every single year, you know, sometimes there aren't any changes that are made and that's great. And I know change can be a hard thing. And you know, not everybody likes to go through that process, but it is extremely important. And you know, sometimes the plan you're on is still good for the next year. If there are significant enough changes in your plan, you know, sometimes that can affect your pocket book.
And if you're able to see those changes and maybe make a switch to a different plan, you know, that could help save you, sometimes thousands or tens of thousands of dollars. Another variable that comes into effect here is pharmacies. Every single one of these drug plans that is offered, they have pharmacies that are in their preferred list where you should be getting a better price or other pharmacies are maybe a standard cost sharing pharmacy where you can still go there, but you might pay a little bit more than at a preferred pharmacy.
And then other pharmacies might be completely out of network where you really should not go there because you're going to be paying quite a bit. So you want to steer clear of that and that can change from year to year, where these plans can pick up or drop some of these pharmacies at different levels and that affects you and your pocketbook.
Host: You know, Ben, I've learned a lot through this five-part series and one of the things I've learned besides D for drugs, I'm gonna make note of that one. I'm going to tuck that one away. That certainly makes it easy. I see the commercials all the time, Medicare part D. Now it makes sense D for drugs. Got it. So the other thing I've learned is that there are a lot of particulars when it comes to Medicare. Dates. One time you, in one of the previous episodes you were referring to blood and it's they don't cover the first three pints, but all the blood after that. Very specific. Right. So maybe we should, as we're here in the last episode, kind of just go back over quickly. Who is Medicare for? How can they enroll? Where can they find the answers to certainly the lingering questions they're going to have, even though we've done this great series?
Ben: Absolutely. So Medicare is for anyone who is getting ready to turn 65, and is going to be losing their group coverage, whether it's through an employer or private health insurance. It can also be for people who are under the age of 65, if you qualify due to a disability or a medical condition. And everybody's going to fall into one of three enrollment periods, really, the initial enrollment period, the general enrollment period, or the special enrollment period.
And you know, the hope is that you would utilize either the initial enrollment period when you start going into it at 65 or the special enrollment period, if you or a spouse worked later, where the general enrollment period, that's where someone could end up getting a penalty. Okay. So hopefully you don't fall into that category, but we can certainly help you out if you do.
And then A is all about your inpatient hospitalization. That's going to help with those hospital bills, skilled nursing facility care, home health care, hospice for the terminally ill. Part B is all about your outpatient, regular doctors and specialist visits, therapies, durable medical equipment, and A and B together are known as original Medicare.
Now part C is Medicare Advantage, MA plans. That is something where if you have A and B you don't need C. If you do take out part C, a Medicare Advantage Plan, then you are essentially removed from A and B. And now you have a private health insurance company that has contracted with Medicare.
And now they're kind of taking over and dictating where you can go and you know what you can and cannot do. Then part D is prescription drug coverage. So, you know, some of those MA plans will have drug coverage within them, but not all of them. So that's definitely something that you want to make sure that, you know, and get the coverage that you need.
But if you go with A and B, then you're probably going to want to pick up a drug plan as well, in order to help with those prescription drug costs.
Host: Yeah. So it seems like you either go with A and B or C, right? Cause we learned in a previous episode, you don't do A, B and C, so it's A and B or C.
But if you did A and B, then you'd take part D or if you did C, you can also do part D so I'm, beginning to connect the dots. Thanks to your wealth of information that you've shared with us here, Ben. If folks want to learn more, want to have longer conversation, want to hire you for your services, how can they reach you?
Ben: Absolutely. My cell phone number or my email address are the best ways to get in touch with me. My cell phone number is (608) 354-3869. Or my email address is This email address is being protected from spambots. You need JavaScript enabled to view it. . And I'll spell that for you. It's This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: Well, that's awesome. As has this series been, this five-part series. We hope folks, you know, listen to all five parts, but maybe if they already know about part A and they want to learn more about part C or whatever it might be, they can pick and choose, but we hope folks will go through and listen to all five parts. And if you made it all the way through, hopefully you enjoyed it and you learned. Cause that was really the goal here was to educate folks, to help them to better understand Medicare and all the respective parts and dates and particulars. Ben, this has been great. Thank you so much for your time and you stay well.
Ben: Thank you, Scott. I appreciate you having me.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb. Stay safe and be well.
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part five of our five-part series on Medicare. For anybody who is eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D is Ben Rothering. He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. So Ben, welcome back to the podcast. We're in our last episode, in this five-part Medicare series that has been really educational and really answered a lot of questions for me. And I'm sure for listeners as well. We talked way back in episode one about enrollment and dates and particulars. We've covered parts A, B and C, and today drum roll please, today, Ben is going to talk part D. So I'll let you do that.
Ben Rothering BS Education (Guest): So part D is all about prescription drug coverage, so D for drugs, right? So a drug plan is something that you are definitely going to want to have. Whether you take prescription medications or not, enrolling in a drug plan is voluntary. However, if you enroll outside of your enrollment period, into a drug plan, there's potential that you would end up getting a penalty for that late enrollment. And the penalty is 1% per month, on top of your base premium for the rest of your life, as long as you have Medicare.
So even if you take zero prescription meds at this time, it's still an important thing to have to make sure you don't get a penalty down the road. There are several different drug plans that are offered. In different states, and it can vary, every single year. These prescription drug options are run by private insurance companies that are approved and under contract with Medicare and a prescription drug plan is going to help cover the cost of prescription drugs only. So brand names or generic meds. It Is not going to help with anything that is over the counter, vitamins or anything like that.
And the hope is that it's going to help lower your prescription drug costs and help protect against some of the higher costs in the future. I can't stress enough how important it is to review your drug plan every single year, during open enrollment from October 15th to December 7th. This is an opportunity for everyone who is on Medicare and has a drug plan to take a look at the plan that they currently have and see any of the changes that were made. And there are a lot of variables that go in to the changes that are being made and how that could affect your pocketbook. So again, I can't stress enough how important that is to really take advantage of that timeframe because all of these variables, whether it's the premiums of every drug plan or the deductibles or the way that every individual drug plan covers your meds, you know, all of those things can change. Your own individual med list can change as well. So, it's very important to take a look at these things and all of these different plans that are being offered, they don't have to cover your meds the same and it can change from year to year.
So you could literally take your med list and look at, you know, prescription plan A, B and C, and A B and C could cover one of your meds totally different. One could cover it as a tier one preferred generic med and maybe they give it to you for free or have a really, really low copay, plan B could cover that same med as a tier two generic med. And now maybe you have a little bit of a higher copay and, you know, plan C could cover it as a preferred brand name. So maybe now you're paying out of pocket until you meet your deductible. And all of that can change from year to year. I know in my experience, with talking with my clients and helping review their drug plans every single year, you know, sometimes there aren't any changes that are made and that's great. And I know change can be a hard thing. And you know, not everybody likes to go through that process, but it is extremely important. And you know, sometimes the plan you're on is still good for the next year. If there are significant enough changes in your plan, you know, sometimes that can affect your pocket book.
And if you're able to see those changes and maybe make a switch to a different plan, you know, that could help save you, sometimes thousands or tens of thousands of dollars. Another variable that comes into effect here is pharmacies. Every single one of these drug plans that is offered, they have pharmacies that are in their preferred list where you should be getting a better price or other pharmacies are maybe a standard cost sharing pharmacy where you can still go there, but you might pay a little bit more than at a preferred pharmacy.
And then other pharmacies might be completely out of network where you really should not go there because you're going to be paying quite a bit. So you want to steer clear of that and that can change from year to year, where these plans can pick up or drop some of these pharmacies at different levels and that affects you and your pocketbook.
Host: You know, Ben, I've learned a lot through this five-part series and one of the things I've learned besides D for drugs, I'm gonna make note of that one. I'm going to tuck that one away. That certainly makes it easy. I see the commercials all the time, Medicare part D. Now it makes sense D for drugs. Got it. So the other thing I've learned is that there are a lot of particulars when it comes to Medicare. Dates. One time you, in one of the previous episodes you were referring to blood and it's they don't cover the first three pints, but all the blood after that. Very specific. Right. So maybe we should, as we're here in the last episode, kind of just go back over quickly. Who is Medicare for? How can they enroll? Where can they find the answers to certainly the lingering questions they're going to have, even though we've done this great series?
Ben: Absolutely. So Medicare is for anyone who is getting ready to turn 65, and is going to be losing their group coverage, whether it's through an employer or private health insurance. It can also be for people who are under the age of 65, if you qualify due to a disability or a medical condition. And everybody's going to fall into one of three enrollment periods, really, the initial enrollment period, the general enrollment period, or the special enrollment period.
And you know, the hope is that you would utilize either the initial enrollment period when you start going into it at 65 or the special enrollment period, if you or a spouse worked later, where the general enrollment period, that's where someone could end up getting a penalty. Okay. So hopefully you don't fall into that category, but we can certainly help you out if you do.
And then A is all about your inpatient hospitalization. That's going to help with those hospital bills, skilled nursing facility care, home health care, hospice for the terminally ill. Part B is all about your outpatient, regular doctors and specialist visits, therapies, durable medical equipment, and A and B together are known as original Medicare.
Now part C is Medicare Advantage, MA plans. That is something where if you have A and B you don't need C. If you do take out part C, a Medicare Advantage Plan, then you are essentially removed from A and B. And now you have a private health insurance company that has contracted with Medicare.
And now they're kind of taking over and dictating where you can go and you know what you can and cannot do. Then part D is prescription drug coverage. So, you know, some of those MA plans will have drug coverage within them, but not all of them. So that's definitely something that you want to make sure that, you know, and get the coverage that you need.
But if you go with A and B, then you're probably going to want to pick up a drug plan as well, in order to help with those prescription drug costs.
Host: Yeah. So it seems like you either go with A and B or C, right? Cause we learned in a previous episode, you don't do A, B and C, so it's A and B or C.
But if you did A and B, then you'd take part D or if you did C, you can also do part D so I'm, beginning to connect the dots. Thanks to your wealth of information that you've shared with us here, Ben. If folks want to learn more, want to have longer conversation, want to hire you for your services, how can they reach you?
Ben: Absolutely. My cell phone number or my email address are the best ways to get in touch with me. My cell phone number is (608) 354-3869. Or my email address is This email address is being protected from spambots. You need JavaScript enabled to view it. . And I'll spell that for you. It's This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: Well, that's awesome. As has this series been, this five-part series. We hope folks, you know, listen to all five parts, but maybe if they already know about part A and they want to learn more about part C or whatever it might be, they can pick and choose, but we hope folks will go through and listen to all five parts. And if you made it all the way through, hopefully you enjoyed it and you learned. Cause that was really the goal here was to educate folks, to help them to better understand Medicare and all the respective parts and dates and particulars. Ben, this has been great. Thank you so much for your time and you stay well.
Ben: Thank you, Scott. I appreciate you having me.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb. Stay safe and be well.
