Medicare planning: keep prescription drug coverage in mind

Dear Tony: I am retiring on January 1 and have started looking for the right health insurance option for me and my wife who is undergoing breast cancer treatment at a local facility. His cancer drugs are expensive and I’m concerned about Medicare Part D reimbursement. I have diabetes and use the FlexPen, and have prescriptions for high blood pressure. Most are generic, except for diabetic prescriptions. Our Medicare Part B will start on January 1, as my benefits end on December 31. What should I do to prepare for this change in medical insurance? I will be 70 and my wife will be 65 when I retire. —Roger, Las Vegas

Dear Roger: While Medicare Part B is like gold because of what it offers, a cornerstone of Medicare planning is discussing Medicare Part D prescription drug plans. It is imperative to research the Medicare plan Most cost-effective Part D to cover your prescriptions. If a prescription isn’t covered, whether generic or brand name, you’ll have to pay for it out of pocket.

Many Americans are so concerned about their doctors that they have no idea if their prescriptions are covered by their new Medicare Part D or Medicare Advantage drug plan.

Every Medicare Part D plan, whether a standalone Part D plan or a Medicare Advantage plan (also known as Medicare Part C) with prescription drug coverage, has a formulary. If any of your medications are not on this form, you will pay 100% for those medications.

Another cornerstone is understanding the value of the Medigap/Medicare supplement open enrollment period. The Medicare and You handbook, which the government mailed out in September, has a “When to Buy” section on Medicare supplements. It says, “The best time to purchase a Medigap policy is during your Medigap open enrollment period. This 6-month period begins the first month you have Medicare Part B (medical insurance) and are 65 or older. (You can also access the manual online at medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf.)

During this six-month window, you can enroll in any Medicare/Medigap supplement plan without having to answer any health questions and not be denied coverage. After the six-month window, medical underwriting takes place and you may not qualify for a Medicare supplement/Medigap plan.

Many new Medicare beneficiaries explore the option of a Medicare Advantage (Part C) plan. Unlike Medigap/Medicare supplement plans, it has a network of plans to follow. But it can be a good option. With the health issues you and your wife have, you should speak with your doctors about the plans they accept and whether these providers accept any Medicare Advantage plans you may be considering.

Toni King is an author and columnist on Medicare and Medicare issues. For a Medicare health check, email info@tonisays.com or call 832-519-8664.