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The Premium Penalty Waiting Game

Should I just ignore the Premium Penalty and join a Medicare Part D plan when (and if) I ever need prescription drug coverage?


Medicare Part D Prescription Drug Plan enrollment is voluntary and some people we have spoken with simply do not wish to join. On one hand, if you never need prescription drug coverage, then you will save the unused insurance premiums. However, if you need prescription drug coverage in later years, you may pay quite a bit more per month on Part D plan premiums. The decision is purely personal.

Will the Premium Penalty go away?

The late enrollment Premium Penalty is a well debated topic and many people have taken a side of the discussions. After May 15, 2006 many people expected that the Premium Penalty would not be enforced and proposals were made to lift the Penalty for late enrollees. However, the Penalty Policy was not so easilly dismissed.

Again, what should a person do?
As mentioned earlier, the decision to join a Medicare Part D plan depends on each person's personal situation. If you have no need for prescription medications or you are satisfied with your HMO's plan, you may decide not to join a Medicare Part D plan and simply save yourself the monthly premiums. Or you may trust that the President or Congress will change their minds and elliminate the Penalty.

The challenge will arise if the government does not remove the Premium Penalty and you later require more prescription drugs and find it necessary to join a Medicare Part D plan at the "increased" premium level.

From the emails that we have received from our Website users and Newsletter readers, many people are contemplating exactly this question: "Do I join a plan now or wait (save the premiums), and maybe join a plan later at a higher monthly cost, when I really need the plan?" Many of these people are already thinking of ways to avoud the Penalty, like purchasing medication from discount sources or outside the United States.

As noted in another area of our Website, mathematically, if a Medicare participant spends as little as $68.00 on prescription drugs per month, then a Medicare Part D plan with a monthly premium of $35.00 would break-even. Premiums under $35.00 or expenditures higher than $68.00 per month would save you money. Once again, as more information becomes available, each person must consider his or her own personal situation and whether a Medicare Part D plan makes sense.



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    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.