If you are a Medicare enrollee, you likely have a Part D prescription drug plan to help pay for your medications.  You should re-evaluate your plan before December 7 to make sure it is best for you.  Below are a few things you must do.
The Part D program of Medicare provides for an Annual Election Period (AEP) from October 15 through December 7 each year.  During this period, you may join or change a prescription drug plan.  Members are “locked in” to their chosen plan for the calendar year and cannot change plans unless they qualify for a Special Enrollment Period (such as by qualifying for low income subsidies).  Here are five things to know when making decisions about a supplement or Part D coverage.
1. Part D drug coverage is required unless you have other comparable coverage — even if you don’t currently take any prescription drugs. If you currently don’t have prescriptions, you’ll likely pay less than $20 per month for Part D.  But those who regularly take multiple drugs will pay much more.  Check with your physician to see if a cost-saving generic drug can be substituted for your prescription.
Creditable Coverage.  People who have “creditable” prescription drug coverage (coverage that is as good as or better than Part D) are not required to enroll and are often better off in their private plans than under Part D.  They should not consider enrolling in Part D without consulting with their current plan Benefits Administrator.  All insurers are required to notify their Medicare-eligible members of their plan’s creditable coverage status every year.  Examples of creditable coverage include TriCare (coverage for military members and their families), Veteran’s (VA) benefits, and Federal employee group health insurance.  Many Medigap policies that offer prescription drug coverage are not creditable.   Individuals who involuntarily lose creditable coverage are entitled to a Special Enrollment Period.  They have 63 days in which to enroll in a Part D plan.
2. The only way to make sure you are getting the best, least expensive drug coverage is to use the “Plan Finder” tool at the Medicare.gov website. You’ll need your Medicare card to do a specific search.  Line up all your prescription drug bottles so you can input the exact name and dosage of the drugs you take. Then click to compare the least expensive plans.
3. You should compare more than prices when choosing a plan. You’ll want to make sure your preferred pharmacy is included in the plan (the online tool should tell you).  And if you take expensive prescriptions, you’ll want to learn how much exposure you have to the dreaded “donut hole” where you must self-insure a portion of the costs before getting 95 percent “catastrophic” coverage. The comparison tool will help you make that decision.
4. Medicare supplements (Medigap) are easier to compare. Medicare supplements are designed to cover the things that traditional Medicare doesn’t cover, including copayments and deductibles.  Although the plans offered by various insurers have different “brand names,” each plan from category A to N must offer the same standardized coverage — making them easier to compare by price.  And those prices are adjusted every year, so you want to see which plan in your category in your state has become the least expensive.  Compare at Medicare.gov or at private marketplaces like www.ehealthinsurance.com, where you can get personalized assistance in making a choice based on your needs.  Tip: Ask your physician which insurers’ supplement plans the office prefers, based on their experience.
5. Medicare Advantage. One of the ways to avoid the annual hassle of re-evaluating supplements and Part D coverage is to enroll in Medicare Advantage.  These all-in-one plans give you complete coverage for one monthly fee with limited deductibles and copays, and most include prescription drugs. But there is a significant drawback, depending on where you live and the plans that are offered.  You can only use physicians, hospitals and drugs that are included in your plan.  And some physicians will not accept certain Advantage plans.
If you need information about your Medicare options, contact us or call us at 601-987-3000.