Medicare A And B Does Not Equal D

Question: I have Medicare A & B, and I don’t take any medication. I never signed up for Prescription Drug coverage. Now I would like to. My doctor has some medication he wants me to take. They tell me I can’t get drug coverage now. This does not make sense to me.

Answer: Medicare A and B have been around since 1965, and most individuals are used to the idea of having that type of insurance when they turn 65. Although periodically I run into trouble with individuals who didn’t enroll in Medicare Part B.

Medicare Part D is newer. Medicare Part D became a part of our life in June of 2006. The coverage at that time was a new concept and it is harder to get a clear picture of what it does. So let’s go over some basic Part D information.

Part D – Prescription Drug Coverage is NOT like Medicare A & B. It is NOT government provided insurance. Part D is a regulation that requires those individuals who are eligible for Medicare A or B to have Prescription Drug Coverage (Insurance). This regulation includes a penalty for those individuals who chose NOT to enroll in a Part D plan. That penalty is in the form of a premium penalty that is paid when you enroll in a Part D plan later in life.

Now some of us are lucky enough to NEVER take any medication. In that case you could say “No, I will not enroll in a Medicare Part D plan.” If you die before you ever need to fill any medications, you made a good decision. You never paid for insurance that you didn’t need. Most of us do not fit this situational model. Most of us take some sort of medication during our lifetime, which may be why The Centers for Medicare and Medicaid Services, (CMS) requires us to enroll in a Part D plan once we are eligible for Original Medicare A & B.

This is a lot like Automobile Insurance. You know that in order to register a car in New York State you must provide proof of insurance. If you don’t have insurance and you get stopped, you pay a fine (get a ticket). So there is a penalty for not carrying automobile insurance.

Part D is similar, but you don’t get ‘caught’ until you try to enroll later in life into a Prescription Drug Plan. If you chose to NOT enroll in Part D, then later when you decide to enroll in a Part D plan, you may be denied that right to enroll at that particular time. The Annual Open Enrollment Period is in the fall from Oct. 15 to Dec. 7 each year. Your new insurance product would begin Jan. 1. This Annual Open Enrollment Period is the time that anyone can join a new or different insurance product as their needs require. If you have NOT enrolled in a plan up to this point, you may have to wait until then to enroll in a product available to you as of Jan. 1, 2018. With your situation, that maybe frustrating. You have a new medication now in August and would like your coverage to begin now in August. You may have to pay for your medication without Prescription Drug Coverage Insurance that would help pay for it. That is one of the downsides for not enrolling in Prescription Drug Coverage earlier. The second downside for not enrolling In Prescription Drug Coverage is you will notice that you have a premium penalty added onto your insurance premium cost when you do sign up. That penalty is 1 percent for each month you are without Prescription Drug Coverage (insurance). So this year the penalty of 1 percent equals 35.6 cents. Each month you are without insurance you are adding 35.6 cents onto the cost of your premium once you decide to enroll. That doesn’t sound like a lot of money when you are thinking about one month, but if you go one year that becomes $4.27, five years becomes $21.36. That dollar amount is added onto your insurance premium each and every month you are without Part D coverage. That is a monthly premium penalty for the rest of your life, once you sign up. That penalty is not paid once, but forever.

Your question was “Why can’t I sign up for Medicare Part D?” My answer is: “It isn’t the Annual Open Enrollment Period for Part D.”

There may be some Special Enrollment Periods (SEP) that we can use to get you signed up for a plan. A common SEP we use regularly is being a member of EPIC (Elderly Pharmaceutical Insurance Coverage Program). In order to be eligible for EPIC, you must live in New York state, be over 65 and have an annual income of less than $75,000 if single or $100,000 if married. You can apply for EPIC anytime you wish. Once you have EPIC, you then have a Special Enrollment Period (SEP) allowing you to sign up for the Prescription Drug Coverage product you now want. Another common SEP is going into or out of a Skilled Nursing Facility (Rehab Program). This could be because of an injury or illness and often that is when medications need to change.

There are actually 18 different SEP’s that we can use. So you may have more options than you realize. Remember that because you didn’t sign up for Part D earlier, you may have a penalty now.

You also don’t have to sign up for Part D if you have coverage from another source. That coverage could be an employee or retiree plan that covers your medications, or if you are eligible for VA benefits. But that doesn’t sound like your situation. You said you didn’t have any prescription drug coverage and now wanted some.

Much like automobile insurance you don’t really need it until you have an accident. But like automobile insurance, they won’t help pay for what already happened! So I strongly encourage individuals who are eligible for Medicare to make sure they have Prescription Drug Coverage.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at