Repeal of the Medicare Prescription Drug Plan Part "D" Penalty (LEP)

[RobertwG871324]

As senior citizens, my wife and I are part of the Medicare Health Insurance Program.  Unfortunately, we did not sign up for the Medicare Prescription Drug Plan Part "D" when we each turn 65.  Bad mistake.  It was not until 2014 that we were convinced by our insurance advisor to begin participation within the Part "D" program even though we were healthy and not on any prescription drugs.  This decision in 2014 is costing us a total of $300.00 to $400.00 a year in penalty cost added to our health insurance plan.  This is a lifetime penalty as long as you participate in the program.  This is not fair and wrong.  I petitioned my US congressmen with little success.  There response was "ITS THE LAW".  I am not aware of how many senior citizens are out there that are experiencing the same dilemma.  Is there an advocacy group for senior citizens to request Congress to rescind the penalty clause?

[GailL1]

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@RobertwG871324 wrote:

 This is not fair and wrong.  I petitioned my US congressmen with little success.  There response was "ITS THE LAW".  I am not aware of how many senior citizens are out there that are experiencing the same dilemma.  Is there an advocacy group for senior citizens to request Congress to rescind the penalty clause?

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I cannot believe that your Congressman's office gave you such a reply without explaining why it works this way - and not just Medicare.

Insurance, especially the healthcare type, is all about sharing in the risk of a defined group.

Med Part D works very similar to Med Part B - Part B also has a late (sign up) premium penalty.

We all share in the risk in Medicare along with the government in Part B & D.  We each have to pay our share - think of your penalty as just your catch-up dues!

Fair and Wrong?  It wouldn't work out well if we all could just wait until something happens in order to pick up coverage on our way to the doctor or pharmacy.

If you or anybody else had other (credible) coverage which delayed the sign up because you were covered by another alternate and credible coverage- you had an out from the penalty. 

Why would we want to rescind this type of  an "encouragement" to buy when 1st eligible?  Wouldn't we just have more people waiting until they actual needed it to buy it?  Then what happens to the premiums of the people already in the program?  Course I guess we could just say - "sign up when 1st eligible" and never give people another chance to sign up and just tell them when they need an expensive medication - sorry, you are on your own.

Did you and your wife sign up for Part B on time?  Why sign up for one and not the other?

[DeahWA]

I agree with you, and am in the same position, although haven't yet signed up for Part D. My penalty will be enormous if I do so next year. I have long hated health insurance because it has seemed such a scam for basically healthy people.

[GailL1]

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@DeahWA wrote:

I agree with you, and am in the same position, although haven't yet signed up for Part D. My penalty will be enormous if I do so next year. I have long hated health insurance because it has seemed such a scam for basically healthy people.

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Then don't sign up EVER and then you are on your own - so better stay healthy as you age . . . . 65 - 75 - 85 - 95 . . . . . . . Think of your Part D (and/or Part B) late sign-up premium penalty as a "CATCH UP" amount.

[DeahWA]

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@GailL1 wrote:

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Think of your Part D (and/or Part B) late sign-up premium penalty as a "CATCH UP" amount.

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Yeah, I'm just constitutionally opposed to paying for things I'm not using. The whole insurance game is really a racket, as far as I'm concerned. 

[GailL1]

People don't "use" any type of insurance UNTIL they have to use it.  But unless you sign up and pay, it isn't gonna be there for you if and when you might need it.

There are Part D plans in most areas that have 000.00 (zero) premiums - so if you don't use it - no harm / no foul - but it is there if you do happen to need it and if they don't cover the (whatever) med that you might have to take very well, there is still open enrollment available every year so that you can switch to a better plan for your needs.

Why not just sign up for a 000.00 (zero) premium plan when 1st eligible just so you aren't (forever) saddled with a LEP - ? 

[Gorm50]

Big Pharma does NO favors to US consumers. As I understand the ONLY entity empowered to negotiate prices is VA. Also, said if I needed a costly drug I would check out VA first.  

Can remember when I could not understand WHY Bush would ever endorse this Part D drug coverage.  Here we are saddled in debt, SSA and Medicare on the brink of insolvency,  knowing that seniors live longer and that exacerbates BOTH SSA and Medicare problems.  

I think Trump had the right idea in mandating the Big Pharma could not victimize us while charging much less to other countries. We were their CASH COW!!  Makes no sense we enhance their profits!!

[GailL1]

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@Gorm50 wrote:

Can remember when I could not understand WHY Bush would ever endorse this Part D drug coverage.  Here we are saddled in debt, SSA and Medicare on the brink of insolvency,  knowing that seniors live longer and that exacerbates BOTH SSA and Medicare problems.  

At least up until 2020 (when Covid hit us), there was nothing wrong with the SMI Trust Funds of Medicare Part B & D..  Why - because they are determined to be pretty much self-paying.  Premiums are adjusted in both Medicare Parts B and D to cover any overage usage.  Remember we pay premiums that are based on about 25% of the actual usage and the government picks up the other 75% out of the General Fund.

I say, until this year because cost due to Covid skewed the % cost and the government %  payments - the government has paid more of a share due to the pandemic.

[Gorm50]

While my Rx costs total $44.44 a year private pay, I question whether an alternative insurance plan would benefit you?  My Medicare Advantage plan strikes me as overly generous on just about everything else, so I would expect their Rx coverage is also excellent.  Just a thought!

[somarco]

@Gorm50   MAPD plans have an Rx benefit built into them. This includes the $0 premium plans. In general, the Rx baked into an MAPD is nothing spectacular, and I rarely see it having lower copay's than a stand alone drug plan.

As @GailL1 mentioned, if you owe an LEP you will not escape it by going with an MAPD plan.The LEP is payable for life and increases every year.

I am not on any maintenance med's and my wife only has an HRT med. Her copay using GoodRx is about 30% less than the copay on her $7 PDP. I also have that PDP even though I have never used the plan.

I have a few clients that "opted out" of Rx coverage when they went on Medicare. They saw no benefit in buying a plan they "would never use" (their words, not mine). As they aged and needed medication they will call and ask about getting a plan. For some of them the LEP is $30/month or more. Rather than getting a plan they just stay the course.

Frankly, the Part D is not impressive unless you have a condition that requires a higher priced brand name drug. I have a few clients on Eliquis. Their drug plan brings the copay down to something affordable once the plan deductible is satisfied.

[GailL1]

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@Gorm50 wrote:

While my Rx costs total $44.44 a year private pay, I question whether an alternative insurance plan would benefit you?  My Medicare Advantage plan strikes me as overly generous on just about everything else, so I would expect their Rx coverage is also excellent.  Just a thought!

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The late sign up premium penalty for Part D (and/or Part B is assessed irregardless) of how one gets their Medicare benefits.