Why Did My Medicare D Plan Not Pay For My Prescription In January?


PillEvery year, at this time, people with Medicare D, the part of Medicare that is used to pay for drugs at pharmacies, tend to forget that Medicare D plans can have deductibles.

Medicare adjusts the plan’s deductibles each year.  Medicare raised the deductible to $310 for 2014 for a basic plan.  While there has been much attention drawn to the phase-in of the plan to eliminate the “Donut Hole” by 2020, increases to the plan’s cost sharing features have not gotten the same publicity.

I admit that for those few Americans who must pay the extra “Donut Hole” prices in November and December, Obamacare has been helpful.

However, while CMS has been removing cost charges in the “Donut Hole” they have quietly been changing the cost-sharing features for all Americans with basic Medicare D plans by raising the plan’s deductible.

Many Americans pay a larger premium for their Medicare D plan for a policy with a lower, or no deductible.

If you have a Medicare D plan, but have had to pay full-price for your prescriptions in January or February, it may not be correct to get upset with your insurance company.

Before you call your insurance company and “give them a piece of your mind,” read your policy and a letter you got back in September (as if anyone can remember back that far).  Unless you have just enrolled in Medicare D, you got a letter last September called an “Announcement of Change.”   In it, your insurance company explained the new deductible increases, if any, that would apply to your policy in 2014.

It was up to you to react to that letter and either change your plan during the annual enrollment or allow your current plan to renew in 2014 with the new deductible.

If you have a Medicare D plan with a deductible, you will need to pay full price for your applicable drugs in 2014 until you have paid the full amount of your deductible.  After you have done that your Medicare D plan will pay for your drugs, each month, according to the payment schedule in your policy.

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