Annual Medicare Part D Open Enrollment Begins
Every year, those who have enrolled in a Medicare Part D prescription drug plan may select a new plan between October 15th and December 7th for an effective date for January 1st.
Should I Consider Changing Plans?
Every individual who has experienced service problems with a plan; goes into the donut hole or gap (the part of the year you pay more of the cost of your prescription medications); or has concerns about a plan because it’s been sanctioned by the government, should consider changing.
How Do I Do the Review?
To review options, go to Medicare.gov and select “Find Drug and Health Plans” in the lower left corner. You will need to enter your zip code, answer whether you receive extra help to pay for your Part D Plan, the list of drugs you are currently taking, and your preferred pharmacy. You will then be provided with a list of Part D Plans that are available in your area. You can compare up to three plans at a time. Here you can see if your drugs are on the plans’ formularies, drug copays, when you hit the donut hole, prior authorization, step therapy, and quantity limits.
This is a helpful tool in deciding whether or not you may want to switch to a new plan but experience with the site varies. It can be very user-friendly but at other times frustrating because too many people are accessing the site and screens can freeze. If that’s your experience, try again later.
Healthcare Navigation does this analysis every year for our subscription clients. Using this tool provides important information but our experience suggests that it is not desirable to keep changing plans unless your current plan provides poor service or you are apt to save more than several hundred dollars by changing. Of course, if projected savings are significant, you should definitely consider changing plans.
The best strategy is to select a highly reputable plan when one first enrolls in Medicare Part D and hope that Plan serves you well over time. At the same time, don’t enroll and expect to be in the same Part D Plan forever.
If or when you decide to make a change, understand the potential pitfalls. The process can be rocky. Your application can be lost so you need to be prepared to follow-up with the plan you selected. You’ll need new cards and your pharmacy needs the information on the new cards. Also, most people on Social Security choose to enjoy the convenience of having Part D premiums withheld from their Social Security payment. Changing Part D Plans disrupts that process and can create a need for months of follow-up to determine that one hasn’t overpaid and that deductions are being made appropriately.
When Do I Have to Change Part D Plans?
If you move out of state, that creates a Special Enrollment Period for you and you can enroll in a new Part D Plan. The address on your Part D application should always match what Social Security has on file as your official residence.
If you have enjoyed retiree medical benefits that provided prescription drug coverage and those benefits end, you should enroll in a Part D Plan.
If you elected COBRA which is ordinarily not a desirable option for most individuals over 65 but can be for some and COBRA is ending, you should plan to enroll in a Part D Plan to coincide with the end of your COBRA coverage but no later than 63 days after the COBRA ends.
If you enroll in a Medicare Advantage Plan that does not include drug coverage, you need to enroll in a Part D Plan.
Finally, if you are on a Medicare Advantage Plan with drug coverage and decide to return to original Medicare, you should also enroll in a Part D Plan.
The Affordable Care Act
Generally, you are locked into your Part D Plan choice until next year’s annual open enrollment unless you have an event like moving or other benefits ending. If you are unhappy with your Part D Plan, the Affordable Care Act included a provision which allows you to switch one time a year outside of the open enrollment period. But you are only eligible to enroll in a Part D Plan that has received a five star rating from Medicare and that remains a work in progress in many areas.
When Is the Donut Hole Closing?
The Affordable Care Act includes a provision to close the donut hole in 2020. Until 2020, the percentage you pay for brand and generic name drugs will slowly decrease each year.