There are many misconceptions about the confusing topic of Medicare Part D. We are here to clear that up! Take a look at four common myths and how they compare to the FACTS.
Medicare Advantage Plans are better than original Medicare
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with health benefits. These plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. While some may argue that Medicare Advantage plans are advantageous, we urge you to take a closer look before signing up on one.
Patients are enticed by the out of pocket maximums (a limit for how much people will spend on healthcare co-pays); a feature that original Medicare does not possess. However, most people do not even reach this out of pocket maximum, making its attractiveness a moot point.
Additionally, Medicare Advantage Plans hinder flexibility within your health coverage. A patient might first have to see a primary care physician before getting a referral to see a specialist. Even then, their options are limited; many doctors are out-of-network with specific Medicare Advantage plans. If switching a patient to a Medicare Advantage Plan with Part D, make sure you examine all aspects of the patient's medical coverage.
Dual Eligible Patients always pay a $0 premium
Many people think that all of their dual eligible patients should be paying a $0 premium no matter what plan they are on. Another myth is that dual eligible patients can only sign up for certain plans. Both of these assumptions are incorrect. A dual eligible patient can sign up for any plan and their Medicaid or state coverage will pay for a certain amount of their premium and some of their co-pays. Each state or region has a certain "benchmark" premium. Say the benchmark is $30. If the patient signs up for a plan that is $30 or less, they won't have to pay anything for their premium. Anything over that benchmark, the patient is responsible for the difference. Check out our blog to learn more about the benchmark premium in your area.
Being a preferred pharmacy is always better
The word "preferred" may have a positive connotation but it does not mean that being a preferred pharmacy is always the most beneficial. While many of your patients' co-pays will be lower at your pharmacy, your preferred status can also be accompanied by PBM chargebacks called DIR (Direct and Indirect Remuneration) fees. iMedicare can show you what these fees are for every script that you process so you can decide for yourself whether it is a good fit for you. For more information on DIR fees and how you can avoid them, click here.
Patients can enroll in Medicare at any point
This is a common misconception that can result in large penalties for the patient. The patient has the opportunity to enroll in Medicare Part D three months before their 65th birthday, the month of their 65th birthday, and three months after their 65th birthday. If the patient fails to enroll during this time, they must wait until the general Open Enrollment Period (October 15th- December 7th). For every month that a patient does not have creditable drug coverage (coverage that is of equal comparison to Medicare Part D Plans), a penalty will be added to their monthly premiums once they enroll in coverage. This is calculated with the following equation:
1% x $33.13 x # of months eligible for Part D = additional cost to the monthly premium
If you have any patients that will be paying a penalty when they enroll, you can click on this easy penalty calculator to find out the additional cost on their monthly premium. Take a closer look at this penalty by reading our blog post here.