Medicare Part D Late Penalty

When Do I Have To Pay A Late Penalty For My Medicare Part D Prescription Drug Plan?

One of the worst surprises for someone on Medicare are unexpected costs. The prescription drug benefit is voluntary, but if you don’t enroll when you first become eligible, you may have to pay a hefty late enrollment penalty if you choose to sign up at a later date.

You are charged an extra 1% of Medicare’s national average drug insurance premium for each month that you did not have prescription drug coverage as good as Medicare’s but could have.

If you have other coverage, the person who administers your benefits will tell you whether your coverage is creditable, meaning comparable to Medicare’s coverage. The 1% percentage will grow until you enroll in a drug plan.

Here is An Example: Anne turns 65 in February 2010. She has through May 2010 (three months after she turns 65) to enroll in a plan without penalty. Although she has no other drug coverage, Anne chooses not to enroll in a prescription drug plan.

In August 2010, she becomes ill and decides that getting drug coverage now would be a good idea, but she can’t enroll until the next ‘enrollment’ opportunity, which is November 15 through December 31 of 2010. Her coverage will start on January 1st 2011.

She is now seven months ‘late’ in enrolling (from June through December), and must pay an extra 7 percent in monthly premiums as long as she has Medicare prescription drug coverage.

You can see that it really is a good idea to get your Medicare Part D Prescription drug plan at the same time when you first enroll in Medicare!

Is An Aetna Medicare Part D Rx Plan (PDP) Right For Me?

When selecting a Medicare Part D plan, it is important to know that you will receive the benefits you need. You want to find out if your prescriptions are covered by the plan, if it includes doctors, hospitals and pharmacies in your area and whether your health care provider accepts the plan.

Aetna Medicare offers three different Part D plans that provide Rx coverage in each state. You can choose among the Aetna Medicare Essential, Plus or Premier Rx plan.

Aetna Medicare Part D Rx plans provide:

• More than 60,000 pharmacies in the national network
• Coverage for most Medicare Part D prescription drugs
• $0 deductible in most plans
• Convenience and savings opportunities using the prescription drug mail order program
• Predictable co-pays to help you manage prescription drug costs
• A safeguard against unforeseen changes in your prescription drug needs

The Aetna Medicare Part D RX plans have many benefits, but also some limitations.

Is My Pharmacy Included?

While Aetna Medicare Part D Rx Plans (PDP) cover most of your Part D brand-name and generic prescription drugs, you need to check the Aetna Medicare Preferred Drug List, also known as the Aetna formulary, to find out with brand-name and generic drugs are included. You can call Aetna Member Services toll-free number at 1-800-213-4599 to get the list or download it from their website.

To fill your prescription, you have more than 60,000 network pharmacies to chose from. Check with your current pharmacy to see whether it is included, and if not, call Aetna Member Services toll-free number at 1-800-213-4599 to find a pharmacy close to you.

Home Delivery

With Aetna Rx Home Delivery® Aetna offers a prescription mail service for Aetna pharmacy benefit members for their maintenance medications that treat chronic conditions such as arthritis, asthma, diabetes, high cholesterol, heart conditions, or high blood pressure. The Aetna Specialty Pharmacy service also provides convenient, mail-order services for medications that require special handling, storage or shipping. These are drugs that treat certain conditions such as hepatitis, psoriasis, rheumatoid arthritis and multiple sclerosis.

Can I Get Reimbursement If I Use An Out Of Network Pharmacy?

When you get your prescription drugs a pharmacy that is not included in the Aetna network, you may have to pay the full cost of the drug when you get your prescription. To be reimbursed for Aetna’s share of the cost of the drug (minus your copay), you have to submit a claim form to Aetna. You may need to pay an additional cost for drugs received at an out-of-network pharmacy. Make sure to submit your claim within three months after the end of the plan year.

How Often Can I Refill?

Aetna’s refill policy promotes the safe and appropriate use of medications. Follow these guidelines for getting refills on your prescriptions:

Retail Pharmacies

• You may refill a supply of 9 days or less after you have used 50 percent of the prescription.
• You may refill a supply of 10 days or more after you have used 75 percent of the prescription.

Mail Order Pharmacies

• You may refill a supply of 30 days or less after you have used 50 percent of the prescription.
• You may refill a supply of 31 to 60 days after you have used 60 percent of the prescription.
• You may refill a supply of 61 days or more after you have used 66 percent of the prescription.

Even if you don’t take a lot of prescription drugs now, getting Medicare Rx coverage when you become eligible helps you avoid penalties in the future and ensures you are covered if you need to take prescription drugs in the future.

Humana Medicare Advantage Plans 2010

Nearly 4 million members nationwide have chosen Humana for their Medicare health coverage needs.

With almost 50 years of history in the health industry, Humana makes it easy for you to pick the plan that fits your lifestyle, your coverage needs, and your pocketbook. You can select between:

• Humana Medicare Advantage plans offer more benefits than Traditional Medicare, at no monthly or an affordable premium, so your health care costs are predictable. You will find many doctors in many areas in the Humana health care provider network.
• Humana Medicare supplement plans cover gaps in Traditional Medicare coverage such as deductibles and coinsurance.
• Humana Medicare prescription drug plans can help relief you from the high costs of medications. Humana offers three stand-alone drug plans that are available in most areas, so you can select the one that best fits your needs and your personal budget.

Humana Medicare Advantage plans are offered as HMO (Health Maintenance Organization), PPO (Perferred Provider Organization), PFFS or special needs plans.

Many people select the Humana Gold Plus HMO plan, because it offers broad coverage including all the benefits of Traditional Medicare and may include prescription drug coverage and many extras. The out-of-pocket costs are lower and more predictable than with other types of plans. So you will have a good idea of how much you’ll spend on healthcare during the year.

Another very popular Humana Medicare Advantage PPO plan is the HumanaChoicePPO® which gives you freedom to select the doctors, specialists, and hospitals you visit. You have the freedom to choose any doctor or hospital, but you pay less for services received from in-network providers. Predictable copayments and coinsurance make it easier for you to budget healthcare costs.

Humana Gold Choice® is a very flexible Medicare Advantage Private Fee-for-Service (PFFS) plan. You can see almost any health care provider as long as they accept Humana’s terms and conditions of payment. Most Humana Gold Choice Private Fee-for-Service plans combine all the benefits of Original Medicare, prescription drug coverage and many extras into one simple, easy-to-use plan.

In addition to Medicare health plans, Humana offers many wellness and prevention programs and services, which may save you money and make it easier for you to stay active for years to come.