Toni Says

by Toni King


Why Are Medicare Part D Rules So Confusing?

Hello Toni:

I received my payment invoice from the Medicare Part D plan I recently enrolled in, and I am simply confused  It shows for February,2021 premium $7.30 and February Late Enrollment Penalty $7.60.  I had enrolled in Medicare Part B after losing my job due to COVID-19 layoffs.

             I applied for Medicare Part B with the Medicare form CMS-L564 “Request for Employment Information” signed by my HR department and to begin January 1st.  My Medicare Part A began June 1, 2018 when I turned 65 and I have been covered with employer benefits including prescription drug plan until December 31, 2020 when my company insurance ended. I do not understand any of this!  Brad from Salt Lake City, Utah

Brad:

America is not aware that Medicare Part D prescription drug plan’s penalty date starts when Medicare Part A begins not when Medicare Part B starts. Brad your Part A started June 1, 2018 and that is when your Medicare Part D penalty began.

            After you enrolled in your current Medicare Part D plan, you should have received a letter that requested you to inform that specific Medicare Part D plan what type of “creditable” prescription drug coverage you had from June 1, 2018 to January 1, 2021.

             This letter explains what you should do to inform Medicare what prescription drug coverage you have had by either calling an 800 number or the letter has a form describing what type of coverage you had which you can mail back to the Medicare Part D plan you enrolled in.

            Many fail to open this letter or understand the importance of notifying the Medicare Part D plan regarding what type of “Creditable” prescription drug coverage they were enrolled in. 

            I believe this is what happened to you, Brad because there is a specific time limit to respond, or you will receive a “Late Enrollment Penalty” not for one month but for as long as you are enrolled in a Medicare Part D plan.

             The Medicare & You handbook states: “Creditable prescription drug coverage could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the VA or health insurance coverage.  Your plan must tell you each year if your non-Medicare drug coverage is “creditable coverage”.  This information may be sent to you in a letter or included in a newsletter from the plan.” 

            Medicare does not acknowledge discount prescription drug cards or low-cost generics programs such as GoodRX as “creditable coverage” and enrolling in one cannot keep you from the “Late Enrollment Penalty”.
       
            Brad, your “Late Enrollment Penalty” may have been because you waited past the 63-day window to enroll in a Medicare Part D plan and was without creditable prescription drug coverage after leaving your company benefits.  Maybe your company’s prescription drug benefits (not health benefits) which you left last year was not creditable as defined by Medicare and that caused the “Late Enrollment Penalty”. These are two different ways may have caused you to receive the Part D penalty listed on the invoice from February.

**Reader Alert:  Please open all mail from Medicare, Social Security, or Medicare insurance plans which you have enrolled in because you never know what they are requesting from Medicare.  Contact the Toni Says® office for questions regarding Medicare enrollment issues. We are happy to guide you through the Maze of Medicare! **

2021 Confused about Medicare Zoom webinar is Thursday, April 29th at 4:00 PM. Visit www.tonisays.com to sign up for Toni’s new webinar event.

            Toni King, author of the new 2021 Medicare Survival Guide® Advanced edition offers a “Thank You to Toni Says® Medicare column readers” with a $5 discount available at www.tonisays.com.