TONI SAYS: Is Medicare or the Part D drug plan more important when retiring?

Janie Slaven, The Times-Tribune, Corbin, Ky.
·3 min read
13

Nov. 16—Toni:

I am retiring January 1 and am beginning to search for the right Medicare option for me and my wife, who is having breast cancer treatment at a local facility. Her cancer drugs are expensive, and I am concerned about the Medicare Part D out-of-pocket. I am diabetic and using the FlexPen, and I have prescriptions for high blood pressure. Most are generic, except for the diabetic prescriptions.

Our Medicare Part B will begin January 1 as my company benefits will end December 31 of this year. What should I do to prepare for this medical insurance change? I will be 70 and my wife will have turned 65 by the time I retire. I want to be sure I do this correctly. Thanks.

—Roger, Las Vegas

Great question, Roger:

Because everyone's situation is different, we at Toni Says will help you tailor your Medicare plan to best fit your requirements, taking into consideration your spouse's and your health needs and the drugs you take.

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 search for the most cost-effective Medicare Part D prescription drug plan to cover your prescriptions. If a prescription is not covered, whether generic or brand-name, then you will have to pay for it out of your own pocket.

Many Americans are so concerned about their doctors that they completely miss whether their prescriptions are covered under their new Medicare Part D or Medicare Advantage prescription drug plan. (Chapter 5 of the Medicare Survival Guide Advanced edition discusses Medicare Part D and the famous "donut hole" coverage gap in detail.)

Every Medicare Part D plan, whether it is a stand-alone Part D plan or Medicare Advantage plan (also known as Medicare Part C) with prescription drug coverage, has a formulary. If any of your drugs are not on that formulary, you will pay 100% for those drugs.

Another cornerstone is understanding the value of the Medigap/Medicare Supplement Open Enrollment Period. The Medicare and You Handbook, which the government mailed in September, discusses "When to Buy" a Medicare Supplement. It states, "The best time to buy 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 you're 65 or older." (You can also access the handbook online at https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf.)

During this 6-month window, you can enroll in any Medicare Supplement/Medigap plan without having to answer any health questions and not be denied coverage. After the 6-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. While, unlike Medigap/Medicare Supplement plans, it has a plan network to follow, it can be a good option. With the health conditions that you and your wife have, Roger, you should speak with your doctors about what plans they accept and/or whether those providers accept the Medicare Advantage plans that you may be exploring.

As you can see, understanding the complexity of Medicare is exhausting. You can find more Medicare information (along with information on retirement housing, senior care, financial planning and much more) at www.seniorresource.com. (Toni Says Medicare Moments podcasts are also available on this website.)

For information on how to personalize your Medicare to meet your needs, you can sign up for the Confused about Medicare Zoom Webinar on Wednesday, Nov. 16, at 4 p.m. CST. Visit www.Tonisays.com for the registration link.

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