If you have original Medicare and take prescription medication, you are most likely enrolled in a Part D Drug Plan that is subject to change each year. By the end of September, your plan will send you an “Evidence of Coverage” and an “Annual Notice of Change.” The annual enrollment period is from October 15th to December 7th. This is your chance to choose the best plan for next year.
Who needs to review their drug plan?
Not everyone finds it necessary to change plans. If you take tier 1 generic drugs with little to no co-pays, any changes to your plan are unlikely to affect you. Should you decide not to make changes before December 7th, your plan will automatically renew for next year.
It is important to review your plan if you take expensive medication. Some folks can literally save hundreds of dollars per year by reviewing and changing their Part D plan! Coverage varies from one plan to the next and can change from year to year.
Again, your current plan will send you an “Evidence of Coverage” and an “Annual Notice of Change” by the end of September.
How can drug plans change?
- Monthly premiums can increase
- Deductibles can go up
- Co-pays can change
- Medications can change from one tier to another
- Drugs can be dropped from the plan’s formulary altogether
- Plans can change their relationship with your pharmacy
Don’t get lulled into a false sense of security! If you are still unsure after reading through the materials sent to you by your current plan, do a review. Better safe than sorry!
Consider that your medications may have changed too
If you have a new prescription, open-enrollment is a good time to choose a plan that has lower co-pays for your medication.
Sometimes doctors prescribe expensive medication outside of the open-enrollment period. This happened to my mom recently. Her doctor prescribed a new inhaler that wasn’t even on her plan formulary. What can you do in that situation?
Since you can’t change your drug plan mid-year, you could pay the full cost of the new medication until you can change to a new drug plan. Or, you could ask your doctor if there is a different medication that might work just as well. If you must take the medication, you could call your drug plan and ask if they may be able to make an exception. You might find that the drug is covered, but you’ll need to meet a deductible first. A change to your medication list is a good reason to review your drug plan.
When can you review your Part D Prescription Drug Plan?
You can begin to review your drug plan October 1st and make changes to your drug plan starting October 15th. If you don’t make changes to your drug plan before December 7th, your plan will automatically renew January 1st for the following year. We recommend making changes before November 30th, as the Medicare website can get glitchy and bogged down as the December 7th deadline approaches.
How can you review your drug plan?
The Medicare Plan Finder at Medicare.gov offers side-by-side comparisons of all the available plans. Any person you choose to help you review your drug plan should make use of this tool. It only takes a couple steps: First, enter your zip code and prescriptions. Next, choose your top two pharmacies. The Medicare Plan Finder will show you how much you will pay in premiums, co-pays, and deductibles for each plan available. For a step-by-step tutorial, see our blog article titled, "Part D Review Tutorial".
However, even if you are comfortable with the internet, you still might want the help of someone very familiar with the program. Scroll to the end of this article to download a Medication Worksheet and request a review.
Don’t take any drugs?
If that is the case, you are probably enrolled in one of the lower premium Part D drug plans or Wisconsin SeniorCare (if you are a Wisconsin resident). Either of these options will help you avoid future late penalties. If you are enrolled in Wisconsin SeniorCare, you need to renew you plan every twelve months, on your policy anniversary. It does not renew automatically on a calendar year basis.
Looking for more ways to control costs?
If you are very low income, you may qualify for extra help paying for your Part D premium and co-pays. Call social security at 1-800-772-1213 to apply. Wisconsin residents may be eligible for benefits through Wisconsin SeniorCare https://www.dhs.wisconsin.gov/seniorcare/index.htm. Some prescriptions qualify for copay assistance through drug manufacturer pharmaceutical assistance programs if you meet certain income guidelines. Often the income limits are significantly more generous.
The bottom line:
Although you may not find it necessary to change your Part D drug plan every year, there are many reasons to do a review, especially if your current plan notifies you of changes that will affect your out-of-pocket costs. You can do the review yourself or ask for help! Programs are available to help with co-pays if you meet certain criteria.
We are here to help!
If you think this article might help a friend, please feel free to send it their way. For more help reviewing your Medicare Part D plan, or other health insurance to go with Medicare, please download a Medication Worksheet and request a review.