Think Twice Before Bypassing Prescription Drug Plan

Today, I’m answering one of the most frequently asked questions that Medicare MarketPlace has received this open enrollment season:

I am turning 65 and don’t take any prescription medications right now. Why should I enroll in a prescription drug plan?  

Nearly 92% of older adults have at least one chronic condition, and 77% have at least two, according to the National Council on Aging.  While you may not currently be on any prescription medication, the chances of you having to take at least one, if not more, in your lifetime increases as you age.  

Let’s say you decide to not enroll in a prescription drug plan when you first become eligible at age 65, but in February of the following year you’re diagnosed with cancer and prescribed Evista. While the full retail cost of the drug varies by pharmacy, we can pull one example to show you roughly how much you’d pay —$199.38 per month. So, at that point you decide to enroll in a prescription drug plan.  

Unfortunately, there are only certain times of the year you can enroll in a Medicare Part D prescription drug plan. Because you didn’t enroll when you first became eligible and the Open Enrollment Period (OEP) runs from Oct. 15 through Dec. 7 for coverage to start Jan. 1, you are not able to enroll.  

The entire cost of the prescription will now come out of your pocket for the remainder of the year. If that is the only medication you’re prescribed, you are out roughly $2,000. If you would have enrolled in a prescription drug plan when you first became eligible, you would have paid far less ­— roughly —$815. (With a Part D prescription drug plan, your costs would be the $320 deductible 11 months of the premium (approximately $15 per month) and a $30 co-pay for the prescription.) Furthermore, waiting to enroll also subjects you to a penalty, requiring you to pay a higher premium for the remainder of the time you are in the Medicare Part D prescription drug plan. 

A Medicare Part D prescription drug plan should be treated like any other insurance plan — you buy the insurance before anything happens and hope that you don’t have to use it. But if and when something does happen, having insurance minimizes your costs.  While it may seem cheaper initially to wait to enroll in a plan, you can see by the above example, it may cost you more in the long run.