When it’s okay to skip Medicare drug coverage

Our resident expert answers readers' toughest questions

Figuring out what Medicare coverage you need—not to mention what you’re paying for your plans—never gets easier. That’s something every senior is reminded of during the annual fall open enrollment period, which runs through December 7.

In his latest answers to reader questions, columnist Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs and the co-author of the updated edition of The New York Times bestseller How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security, explains when you do and don’t need additional prescription drug coverage, as well as how Medicare funding works in the first place. 

Got a question of your own about Medicare or Social Security? Send it to  askphil@considerable.com.

Are Medicare Parts A & B enough coverage?

Judy, Virginia: I am fairly healthy and am not on any medications. I rarely get sick enough to go to the doctor and have no ongoing conditions. Is there any reason I should have other Medicare except Parts A and B?

Phil Moeller: I think Judy has lots of company among healthy seniors. No one likes to pay for insurance if they can avoid it.

In Judy’s case, she will face late-enrollment penalties for Part D drug coverage if she later needs it. These are permanent penalties and equal about 30¢ a month tacked on to the Part D premium for each month she is eligible for Part D but does not have coverage.

Otherwise, the big risk health seniors face is a surprise and expensive medical need—think cancer, a bad accident, etc. Part B covers only 80% of outpatient and doctors’ expenses, so people with only Original Medicare are on the hook for 20% of a potentially large number.

If it was me, I’d get a cheap Medicare Advantage plan. It won’t cost much beyond Part B and will include protection against catastrophic medical expenses.


Why am I being charged for a drug plan when I don’t need one?

James, Maryland: I have been retired for nearly three years and enrolled in Social Security and Medicare when I turned 65. With Medicare, I opted in to Parts A and B. I did not get a Part D drug plan because I was able to stay on the prescription drug plan offered through my former employer.

Upon receiving my first benefit statement from Social Security, I noticed a deduction for prescription drugs that represents a high-income surcharge. Together with what I am paying through my former employer program, my monthly cost for prescription drugs has nearly doubled!

I understand the rationale for high-income Medicare surcharges and am more than willing to pay my fair share. What I don’t understand is why I am making payments for something I don’t have and from which I am deriving no benefit? I also can’t understand why no one informed me of these surcharges in the first place. Could you help me understand this?

Phil Moeller: If you have credible drug coverage from an employer retiree plan, your former employer should be able to provide you a statement to that effect. Credibility means that the retiree plan is comparable to a typical Medicare Part D plan.

Armed with this statement—which employers are legally required to provide you upon request—you should appeal to Social Security to stop deducting Part D payments. In a truly fair world, you’d be able to get refunds of past payments, and I certainly would request this. However, I wouldn’t hold my breath.

In a truly fair world, you’d be able to get refunds of past payments. However, I wouldn’t hold my breath.

Here is Social Security’s general appeals page. There also is a separate page for appeals of Medicare’s high-income surcharges. I have never seen an online form that allows people to challenge Part D payment withdrawals or Part D IRMAA charges. Given that your withdrawal results in you receiving a smaller Social Security benefit than you deserve, perhaps you can use this as the basis for an appeal.

As for the lack of notice about surcharges, this is just one more area where Medicare and Social Security fail miserably in transparency and communications. Trying to get Social Security to do the right thing can be time-consuming and exhausting, but I urge you not to give up.

Am I paying for Medicare twice?


Marilyn,  Georgia: Why do they take Medicare out of my payroll check and out of my Social Security check? It’s like I’m being charged twice!

Phil Moeller: The money taken from your payroll check is used to fund Medicare Part A, which covers hospital and nursing home expenses. People who have worked long enough to qualify for Social Security benefits are entitled to Part A without having to pay a premium.

While the Part B premiums may seem expensive, they actually cover only a fourth of Part B expenses.

Once you’re on Medicare, the premiums for Medicare Part B are deducted from your Social Security payments, assuming you’ve already claimed Social Security.

It may appear as if you’re paying twice for the same thing, but you’re really not. And while the Part B premiums may seem expensive, they actually cover only a fourth of Part B expenses. The rest come out of general federal revenues every year, to the tune of about $400 billion.

These questions previously appeared on the PBS NewsHour Making Sen$e website.