The open enrollment period began Oct. 15.

The first of 54 days that Americans 65 and older have to make their Medicare choices for 2020. These choices could save you hundreds, perhaps thousands of dollars a year and could well determine the quality of your health care, as well as your health, for years to come.

In addition to choosing between Medicare Part A and Medicare Part B, enrollees must also choose between opting into Medicare Part D or not.

Don’t let a lack of knowledge be the reason that you do not choose the best Medicare plan for you. Consider these six things when making your Medicare selection this year.

Medicare’s prescription drug benefit (Part D) is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the federal government—it is never provided directly by the government (unlike Original Medicare).

If you want to get Part D coverage, you have to choose and enroll in a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage (MAPD). Enrollment is optional (though recommended to avoid incurring future penalties) and only allowed during approved enrollment periods. Typically, you should sign up for Part D when you first become eligible to enroll in Medicare.

Whether you should sign up for a Medicare Part D plan depends on your circumstances. You may have creditable drug coverage from an employer or retiree insurance. If so, you don’t need to enroll in a PDP until you lose this coverage. Also, some people already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare drug plan and receive additional financial assistance paying for their medicines.

If you are 65 or older and you qualify for Medicare, here are some things you should consider when opting into Medicare Part D.

How much does Part D cost?

Most people only pay their Part D premium. If you don't sign up for Part D when you're first eligible, you may have to pay a Part D late enrollment penalty. However, you could potentially end up making these payments throughout the year in a Medicare drug plan:


  • Yearly deductible
  • Copayments or coinsurance
  • Costs in the coverage gap
  • Costs if you get Extra Help
  • Costs if you pay a late enrollment penalty

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's network
  • Whether the drugs you use are on your plan's formulary
  • Whether you get Extra Help paying your Medicare Part D costs

If your modified adjusted gross income is above a certain amount, you may pay a Part D income-related monthly adjustment amount (Part D IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS). You'll pay the Part D IRMAA amount in addition to your monthly plan premium, and this extra amount is paid directly to Medicare, not to your plan.

What does each plan cover?

Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies.

Plans include both brand-name prescription drugs and generic drug coverage. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need.

The formulary might not include your specific drug. However, in most cases, a similar drug should be available. If you or your prescriber believes none of the drugs on your plan’s formulary will work for your condition, you can ask for an exception.

A Medicare drug plan can make some changes to its drug list during the year if it follows guidelines set by Medicare. Your plan may change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.

Plans offering Medicare prescription drug coverage under Part D may immediately remove drugs from their formularies after the Food and Drug Administration (FDA) considers them unsafe or if their manufacturer removes them from the market. Plans meeting certain requirements also can immediately remove brand name drugs from their formularies and replace them with new generic drugs, or they can change the cost or coverage rules for brand name drugs when adding new generic drugs. If you’re currently taking any of these drugs, you’ll get information about the specific changes made afterwards.

For other changes involving a drug you’re currently taking that will affect you during the year, your plan must do one of these:

  • Give you written notice at least 30 days before the date the change becomes effective.
  • At the time you request a refill, provide written notice of the change and at least a month’s supply under the same plan rules as before the change.

Does Medicare Part D work with other insurances?

The short and long answer is yes. Medicare Part D does work with a variety of other insurances; however, it does not work with all, nor does it benefit all other insurance policy holders. Be sure to check with your local Medicare Part D specialists to see what the best option is for you and your specific needs.

For example, the types of insurance listed below are all considered creditable prescription drug coverage programs. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.

  • Federal Employee Health Benefits (FEHB) Program
  • Veterans' Benefits
  • TRICARE (military health benefits)
  • Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
  • Indian Health Services

Medicare has a lot of layers and can be quite complicated. It’s difficult to know if you are making the best decisions for you and your individual needs. Luckily, for the local community, The Medicine Shoppe is ready and willing to help determine which Medicare Part D plan is best for you. Stop by 400 Jefferson Ave, Washington, Pa or call 724-222-0900 to talk to a Medicare Part D expert today.

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