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COSSTULAYRVPMOREIIDDSEICSARE your prescription needs. There are about
20 plans available in Maryland (if you
Aby Moshe Nelkin, FSA, MAAA Suppose that you delayed enrolling in Part enroll in Medicare Advantage, you general-
re you or a family member near- B for three years and now decide that you ly have medical and prescription coverage
ing retirement age and starting to should sign up. Since you have gone for packaged together). Every plan has its
think about Medicare? Medicare 36 months without coverage, your penalty own monthly premium and defines a list
plays an important role in ensur- will be an extra 30 percent of the of drugs that it covers, known as a formu-
ing your financial security during Medicare Part B monthly premium (the lary. Plans do not cover every drug,
retirement, but there are some standard Part B premium is $134 per although they must cover a minimum
pitfalls you need to know about month in 2017) each month for the rest of number of drugs in a given therapeutic
so that there are no unwelcome your life. Additionally, you can only enroll category. The formulary also defines how
surprises. between January 1 and March 31, known much you need to pay at the drug count-
as the General Enrollment Period, and er as your co-pay, which can vary from
Sign Up at the Right Time coverage will not begin until July 1. So in plan to plan.
The Initial Enrollment Period (IEP) for addition to the penalties you must pay,
Medicare begins three months before the you also go for a number of months with- You have an opportunity to select the
month that you turn 65 and ends three out medical coverage. appropriate Part D plan when you first
months after the month that you turn 65. sign up for Medicare during the IEP, and
For example, if you turn 65 on July 29, For every month that you delay Part D to change your plan for the following year
your IEP begins on April 1 and ends on drug coverage enrollment, there is a life- between October 15 and December 7 (the
October 31, a total of seven months. In time penalty equal to 1 percent of the Annual Open Enrollment Period). The
this example, if you enroll during April, base beneficiary premium (which was best way to find the plan that fits your
May, or June, your Medicare coverage will $35.67 in 2017) that is added to your needs is to use the Medicare Plan Finder
begin on the first of your birth month, July monthly Part D charge. In the previous on Medicare.gov/find-a-plan. Using this
1. If you enroll in July, your coverage will example, you would need to pay an extra tool, you can enter your exact list of pre-
begin on August 1. If you wait to enroll 36 percent of the BBP each month for as scription drugs and dosages, and the
until August, September, or October, cov- long as you have Part D. Even if you do pharmacies in your area that you may
erage will not begin for two or three not currently take any prescription drugs, use. The Plan Finder will tell you the
months. it is wise to sign up for the cheapest Part amount of the monthly premium and how
D plan available so that you can avoid much you can expect to pay at the phar-
Unless you already receive Social penalties and have coverage in place if macy counter for your specific list of
Security benefits (in which case your there is an unexpected need. drugs for each plan. Plan Finder has
Medicare enrollment is automatic), you information on the CMS quality star rat-
must sign up for Medicare on your own An exception to the requirement to ings assigned to each plan, and if there
through the Social Security enroll at age 65 is actively working people are any restrictions such as prior authori-
Administration (you do not need to claim who have a group health plan through zation, quantity limits, or step therapy.
Social Security benefits to enroll in their current employer that has at least 20 Enrollment in a plan can be done direct-
Medicare). The government does not mail employees. In this case, you can defer ly from Plan Finder.
you a notice or enrollment package that enrolling in Medicare without penalty as
tells you to sign up – but missing the IEP long as you are still working, and up until Do not make the mistake of choosing a
can result in significant penalties that 8 months after you lose your coverage or plan based solely on the monthly premi-
stay with you as long as you have employment, whichever comes first. This um. The majority of your annual cost may
Medicare! The start of your coverage may is known as a Special Enrollment Period be in the form of the co-pays that you are
also be delayed if you miss the IEP, so (SEP). It is important to note that COBRA charged at the pharmacy, and these can
you could have a period without any coverage and health insurance provided to vary significantly from plan to plan. You
medical coverage. retirees by a former employer do not qual- can use the Plan Finder tool to under-
ify for this exception. stand your total cost by adding your annu-
For every 12-month period that you are al premiums and annual drug costs to
eligible for Medicare Part B but do not Choose the Right Drug Plan each other. Spouses should not automati-
enroll, you will be charged an additional Enrolling in Medicare allows you to cally choose the same plan as each other.
10 percent in monthly premiums for as choose a Part D drug plan offered by a pri- Each of you is likely to have a different list
long as you are enrolled in Medicare. vate insurance company to help pay for of covered drugs, and the cost for your
drugs under your spouse’s plan may be
much higher than under a different one.
Another common mistake is to not
review your Part D coverage during
Annual Open Enrollment. Studies show
that as many as 90 percent of seniors stick
74 u www.wherewhatwhen.com u
20 plans available in Maryland (if you
Aby Moshe Nelkin, FSA, MAAA Suppose that you delayed enrolling in Part enroll in Medicare Advantage, you general-
re you or a family member near- B for three years and now decide that you ly have medical and prescription coverage
ing retirement age and starting to should sign up. Since you have gone for packaged together). Every plan has its
think about Medicare? Medicare 36 months without coverage, your penalty own monthly premium and defines a list
plays an important role in ensur- will be an extra 30 percent of the of drugs that it covers, known as a formu-
ing your financial security during Medicare Part B monthly premium (the lary. Plans do not cover every drug,
retirement, but there are some standard Part B premium is $134 per although they must cover a minimum
pitfalls you need to know about month in 2017) each month for the rest of number of drugs in a given therapeutic
so that there are no unwelcome your life. Additionally, you can only enroll category. The formulary also defines how
surprises. between January 1 and March 31, known much you need to pay at the drug count-
as the General Enrollment Period, and er as your co-pay, which can vary from
Sign Up at the Right Time coverage will not begin until July 1. So in plan to plan.
The Initial Enrollment Period (IEP) for addition to the penalties you must pay,
Medicare begins three months before the you also go for a number of months with- You have an opportunity to select the
month that you turn 65 and ends three out medical coverage. appropriate Part D plan when you first
months after the month that you turn 65. sign up for Medicare during the IEP, and
For example, if you turn 65 on July 29, For every month that you delay Part D to change your plan for the following year
your IEP begins on April 1 and ends on drug coverage enrollment, there is a life- between October 15 and December 7 (the
October 31, a total of seven months. In time penalty equal to 1 percent of the Annual Open Enrollment Period). The
this example, if you enroll during April, base beneficiary premium (which was best way to find the plan that fits your
May, or June, your Medicare coverage will $35.67 in 2017) that is added to your needs is to use the Medicare Plan Finder
begin on the first of your birth month, July monthly Part D charge. In the previous on Medicare.gov/find-a-plan. Using this
1. If you enroll in July, your coverage will example, you would need to pay an extra tool, you can enter your exact list of pre-
begin on August 1. If you wait to enroll 36 percent of the BBP each month for as scription drugs and dosages, and the
until August, September, or October, cov- long as you have Part D. Even if you do pharmacies in your area that you may
erage will not begin for two or three not currently take any prescription drugs, use. The Plan Finder will tell you the
months. it is wise to sign up for the cheapest Part amount of the monthly premium and how
D plan available so that you can avoid much you can expect to pay at the phar-
Unless you already receive Social penalties and have coverage in place if macy counter for your specific list of
Security benefits (in which case your there is an unexpected need. drugs for each plan. Plan Finder has
Medicare enrollment is automatic), you information on the CMS quality star rat-
must sign up for Medicare on your own An exception to the requirement to ings assigned to each plan, and if there
through the Social Security enroll at age 65 is actively working people are any restrictions such as prior authori-
Administration (you do not need to claim who have a group health plan through zation, quantity limits, or step therapy.
Social Security benefits to enroll in their current employer that has at least 20 Enrollment in a plan can be done direct-
Medicare). The government does not mail employees. In this case, you can defer ly from Plan Finder.
you a notice or enrollment package that enrolling in Medicare without penalty as
tells you to sign up – but missing the IEP long as you are still working, and up until Do not make the mistake of choosing a
can result in significant penalties that 8 months after you lose your coverage or plan based solely on the monthly premi-
stay with you as long as you have employment, whichever comes first. This um. The majority of your annual cost may
Medicare! The start of your coverage may is known as a Special Enrollment Period be in the form of the co-pays that you are
also be delayed if you miss the IEP, so (SEP). It is important to note that COBRA charged at the pharmacy, and these can
you could have a period without any coverage and health insurance provided to vary significantly from plan to plan. You
medical coverage. retirees by a former employer do not qual- can use the Plan Finder tool to under-
ify for this exception. stand your total cost by adding your annu-
For every 12-month period that you are al premiums and annual drug costs to
eligible for Medicare Part B but do not Choose the Right Drug Plan each other. Spouses should not automati-
enroll, you will be charged an additional Enrolling in Medicare allows you to cally choose the same plan as each other.
10 percent in monthly premiums for as choose a Part D drug plan offered by a pri- Each of you is likely to have a different list
long as you are enrolled in Medicare. vate insurance company to help pay for of covered drugs, and the cost for your
drugs under your spouse’s plan may be
much higher than under a different one.
Another common mistake is to not
review your Part D coverage during
Annual Open Enrollment. Studies show
that as many as 90 percent of seniors stick
74 u www.wherewhatwhen.com u
