Posted by MedEd at MHI
A: That’s a fair question. The Centers for Medicare and Medicaid Services (CMS) says that Part D is voluntary. Here is what Paul Harvey would call “the rest of the story”.
Say hello to Larry. Larry did not enroll in Part D at age 65 because he did not take any medications. While celebrating his 68th birthday in April, Larry ended up with a blood clot. His doctor prescribed a blood thinner. It is a brand name medication with a retail price of $500/month and no generic equivalent.
Larry had to pay full retail for his blood thinner until he could get on a Part D plan. Unfortunately, he had to wait until the October 15 – December 7 Open Enrollment Period to sign up. He enrolled in a plan and it became effective on January 1.
Too bad he had to pay full retail for the eight months before his Part D plan went into effect ($500 x 8 = $4,000).
There’s more bad news for Larry. His failure to enroll in a Part D plan at age 65 or maintain prescription coverage that paid as well as a standard Part D plan resulted in a late enrollment penalty that he will now pay every month for as long as he is on Medicare.
Can you think of anything Larry could have done to avoid paying full retail for eight months and the late enrollment penalty?
How about enrolling in a Part D plan with a low monthly premium? He would have had coverage if and when he needed it as well as protection from the late enrollment penalty.