Part D Late Enrollment Penalty

[StandingA]

Hello, my Medicare coverage begins September 1 and I am trying to decide whether to get a Part D plan. I come from a line of long livers none of whom ever took prescription meds. I don't take any either and am in excellent health.

I understand that if I do not sign up for a Part D plan within 63 days of my eligibility, I will incur a penalty for the rest of my life. But...what happens if I never sign up for a Part D plan? Would there be a penalty? If so, when and how much?

Thank you

 

[Mack]

If you never sign up for a Part D plan there will not be a penalty. The penalty is only for those who sign up late. And the penalty is greater the later you sign up, and persists for the rest of your time that you have coverage.

In my opinion it is foolish to go without drug coverage. You cam get a basic plan for under $20 per month. You will at some point in time get sick or in an accident and need prescription drugs. Without insurance a drug might be $100 or $5000. With insurance it could be a copay of from $0 to much higher, but in any event, even if the drug is not fully covered by your insurance the price will be much, much lower than if you paid out of pocket.

The drug companies give preferred pricing to insurance companies. For example a drug that costs $500 to the uninsured might be $100 to the insurance company. Even if the insurance company does not fully cover the drug, your price for the drug will be $100 or less and not the $500.

Just because you aren't taking a drug now doesn't mean you won't ever.

 

[MBSC]

I am struggling with this decision myself and it's not because of finances. I could easily afford the premium. There is an annual open enrollment period for Part D. So, at most there will be an 11 month period without Part D coverage. Between the Walmart $4 list, GoodRx.com discounts, and a reputable Canadian pharmacy (some are not), there is no need to pay the $500 rack rate should the need arise.

The most expensive drugs are usually administered by infusion in an office/clinic setting, so they fall under Part B coverage. Part D is for self-administered drugs. For me, the gap would be having an outpatient hospital procedure and given a self-administered drug like Percocet in recovery that is not covered by Part B. But the premium savings would cover that charge.

 

[Mack]

What if you become ill and need a drug to get well or manage the symptoms that is not generic? None of are $4 at Walmart.

Of course everyone thinks they won't get sick, won't get in an accident, won't die, etc. In that case you don't even need health insurance at all!

I guess it depends on how much a gambler you are.

 

[MBSC]

What if you become ill and need a drug to get well or manage the symptoms that is not generic?

That was my Father's situation before Part D was created and he used a Canadian pharmacy. Some drugs cannot be imported but may have a Patient Assistance Program. As previously stated, it would only be an 11 month or less transition period similar to how those who have a Part D plan and get a new prescription not on the formulary and without an insurer's exception find ways to avoid paying the rack rate until they can change plans.

Of course everyone thinks they won't get sick...

I have plenty of time to make the initial decision. I KNOW I will be getting sicker than I already am as I age. The point was there are ways to avoid the rack rate for short periods of time.