Medicare Part D

Made Easy

 

 

Introduction

 

While the offered services herein are available as described, Plan Sponsors and their practitioners

may find it useful to follow a simple path.

 

The Simple Path

 

The plan document should be amended as follows:

 

1.      Every covered person who has, or could have, a Medicare Card must elect Medicare Part D as a condition of plan eligibility. It is anticipated that such Medicare Part D premiums will most often be paid by the Plan Sponsor, at least in part.

 

2.      For such select covered persons, the Plan's Rx benefits shall be determined from the Medicare Worksheet provided by CMS (or the PDP if applicable) and shall be defined as follows:

 

 

Where Medicare Part

D pays at the rate of

 

Plan Shall Pay

at the rate of

 

 

75%

 

  

______ %

 

 

0*

 

  

______

 

 

95

 

  

______

 

 

* So-called Donut Hole

 

 

 

 

3.      A Notice of Creditable Service will be given to each covered person showing that the Plan's benefits are not equivalent to those of Medicare Part D and explains to such covered person what the Medicare and Plan Benefits are.


 

Comments

 

1.      The fact that the purchase of Medicare Part D for the light-Rx user is not cost-effective is ignored.

 

2.      The effort to gain the Rx subsidy is too great.

 

3.      The issue of creditable services is taken totally out of the picture because no such event as opting out can occur.

 

4.      Whether the Rx benefits for such select group of covered persons is (a) a Plan Rx benefit funded in part by Medicare Part D or (b) a freestanding Medicare Rx benefit plus a freestanding Plan Rx benefit must be made clear. It appears that either (a) or (b) will be acceptable.

 

5.      For Plan Sponsors wishing Rx benefits not determined by a Medicare Part D worksheet, a special plan amendment should be considered. For example: a benefit such as 50% of the Rx expenses after a $150 Calendar Year Deductible.

 

6.        It is suggested that the plan sponsor consider a separate plan for Rx benefits at once. Also, where justifiable for reasons of size, a separate plan should be considered for all plan covered persons who have or could have a Medicare card.