Question: I have a Part D plan, but now don’t take any medication. So can I drop my Prescription Drug Coverage?

Answer: The Prescription Drug Coverage benefit is not a benefit covered by Medicare, but is regulated by Medicare (Centers for Medicare & Medicaid Services -CMS). The answer could be both yes and no.

You could decide to drop your Prescription Drug Coverage that you currently have with your insurance. If you have coverage from another source and that coverage is as good as or better than what you are getting now (Creditable Coverage), there is no problem. An example of this Creditable Coverage could be VA Benefits, or Prescription Drug Benefits that you get as part of a new job or a new benefit package

Once you become eligible for that new type of coverage, you simply call your Prescription Drug Plan or Medicare (1-800-633-4227) and asked to be dis-enrolled from your Prescription Drug Coverage. In the situations listed previously, you would qualify for a Special Enrollment Period (SEP). That SEP allows you to dis-enroll from your insurance coverage without a penalty in the future (if you want to re-enroll at a later date).

There are also individuals who do not want to pay for insurance if they feel they do not need it. For example, they do not take medications now, so don’t want to pay for a Prescription Drug Plan (Part D). These individuals could drop their Prescription Drug Plan, BUT in the future, if they wanted to re-enroll in a Part D plan, they will have a penalty for each month they did not have prescription drug coverage.

This premium penalty is 1 percent for each month the individual is without insurance. This penalty accrues with each month and then is imposed when you decide to re-enroll in a Prescription Drug plan, if you ever do.

The risk in the decision to drop your part D plan is that you may need it at a time when you cannot easily enroll into the plan you want, OR that when you do enroll in the future, you will have a higher premium to pay due to the premium penalty.

There are Enrollment Periods that we use to determine WHEN someone can enroll in to the different insurance periods. There are also Special Enrollment Periods (SEP’s) that can be used to enroll at different times throughout the year. These Enrollment Periods also apply to DIS-Enrollment. That sounds like funny wording and it is, ‘using an Enrollment Period to DIS-enroll from your plan’.

If your coverage is NEW prescription drug coverage, then you can absolutely drop your Part D plan; that is considered an SEP that can be used to make the change. If you have simply decided to NOT carry the coverage, you may not have an SEP to use.

I will also say if you DO NOT pay the bill for the insurance they will certainly cancel your coverage, but that takes about 6 months to happen. As long as you do not use the insurance card to cover the cost of your medications, and you do not pay the premium, the coverage will certainly end. Like any bill, if you do not pay it, they will cancel the service.

For those individuals who have chosen a plan with NO premium, you cannot use this way to end your coverage. There is not a premium bill to pay, so non-payment does not cancel the insurance.

Now, how to actually cancel the insurance? In all this discussion, I forgot to give you the actual way to cancel the insurance. If you have an SEP to use allowing you to end your coverage, you need to contact your current Prescription Drug Insurance Company and cancel the plan. This contact can be over the phone or by writing a letter. It will always cancel the first of the following month; you cannot cancel the coverage retroactively.

If you are not sure if you are allowed to cancel your insurance at this time, you can contact Medicare and they can help you understand the opportunities you have to make this cancelation work for you. Centers for Medicare Services (CMS) can be reached at 1-800-633-4227. You cannot at this time use the website to dis-enroll from your plan. You must speak with your plan directly or call CMS customer service to terminate your plan. The CMS helpline is available to you 24 hours a day, seven days a week, so call anytime to ask questions and clarify your answers.

I hope this helps you to make your decision on keeping your Part D insurance or cancelling your coverage. This is your decision to make, and there are always pros and cons with every decision. I rarely recommend that someone go without prescription drug coverage.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.