ArcaMax

Hello Toni:

In September, I turn 65 with my Medicare beginning Sept. 1. I recently read your article from Greg in Texas who had received wrong information about enrolling in Medicare when self-employed. I am also self-employed and need your advice about enrolling in Medicare Part D.

Currently, I am enrolled in Amazon Prime’s Pharmacy RxPass and when I am eligible for Medicare, I can enroll in the Prime member’s Medicare senior plan for $5. Will this type of plan be the same as enrolling in a Medicare Part D plan? Please explain what I should do as I am on a fixed budget and cannot afford a Medicare penalty. Thanks, Toni, for your help!

--Abbie from Charlotte, N.C.

Hi Abbie:

In June of 2024, Amazon Prime began a special Pharmacy RxPass program with special discounted rates on prescriptions for those enrolled in Medicare. This program is not classified as a Medicare Part D plan. This is a prescription drug plan like GoodRx and Single Care which also offer less expensive prescription drug prices. Grocery store pharmacies such as Walmart, Kroger and Costco also have discount prescription drug plans. Amazon enlarged its marketing to include both the 65 million Americans who are currently on Medicare and the 10,000 a day who are turning 65, like you, Abbie.

It is important that you enroll in a Medicare Part D plan that covers the prescription drugs you are currently taking. I would strongly advise you not to wait to enroll in a Part D plan during your Medicare Initial Enrollment Period (IEP), which is 3 months before turning 65, the month you turn 65 and 3 months after. If you don’t enroll in a Medicare Part D plan during your IEP, you WILL receive the Part D penalty that you, Abbie, are so dreading.

The 2025 Medicare Part D costs are:

-- Initial Coverage Deductible is up to $590 for 2025 and changes each year.

-- Initial Coverage has 5 drug-tiers; the Part D plan pays its share of the cost of your drugs, and you pay your share until the amount of your out-of-pocket maximum is met. For 2025, $2,000 is the out-of-pocket maximum. Then you move into the Catastrophic Coverage stage and pay $0.

-- Donut Hole (Coverage Gap), effective January 1, 2025, no longer exists -- which is great news for Americans!

Abbie, to enroll in a Medicare Part D plan -- whether standalone or a Medicare Advantage with Part D included -- you must open a medicare.gov account which will have your Medicare information. (More information about Medicare Part D is available in chapter 5 of Toni’s Medicare Survival Guide Advanced edition at www.tonisays.com.)

Once you have opened your Medicare.gov account, you can go online and begin searching for your prescription drug plan by following these steps:

1. Click on “Find health and drug plans.”

2. Verify your “extra help” (based on income), list pharmacies you prefer, and under “Your Drug List” enter ALL of your drugs. Put your prescriptions in the system as a monthly quantity -- not 90 days or 6 months -- because of Medicare’s out-of-pocket maximum rule of $2,000. Using monthly rates lets you know when you will qualify for the $2,000 out-of-pocket maximum and will no longer have to pay the deductible or copay for the rest of the year.

3. Click on “Find Plans Now” to access Part D or Medicare Advantage plans for this year (or next).

4. Select which type of plan you wish to enroll in, either a Part C Medicare Advantage or Medicare Part D (stand-alone) plan. These plans will appear from the least to most out-of-pocket spent for the year.

Review your options carefully, Abbie, because with Medicare, what you don’t know WILL hurt you!

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.s

Copyright 2025 Toni King, Distributed by Counterpoint Media