When Can You Change Medicare Part D Prescription Drug Plans?
If you want to enroll in or change a Medicare Part D prescription drug plan, the time to do so -- called "open enrollment" -- runs from October 15 through December 7, 2012, for coverage to begin January 1, 2013. The same dates apply if you want to enroll in a Medicare Advantage (Medicare Part C) plan that provides prescription drug coverage instead of enrolling in a Part D plan.
When Open Enrollment Might Not Apply to You
Are you a Medicaid recipient? If you receive benefits through Medicaid (called Medi-Cal in California) as well as Medicare, you can enroll in or switch to any Medicare Part D drug plan at any time.
Are you a nursing home resident? If you're a nursing home resident, you can enroll in or switch to any Medicare Part D drug plan at any time.
Are you a new Medicare enrollee? When you initially sign up for Medicare, you can enroll in any Medicare Part D prescription drug plan -- or a Medicare Advantage plan with drug coverage -- that's offered where you live anytime within the three months following the month in which you first sign up for Medicare, as well as the three months before.
Why You Might Want to Change Prescription Drug Plans
This is the annual opportunity to make a better choice for your circumstances. There are several reasons why you might need or want to switch Medicare prescription drug coverage.
Drug coverage changes. Every October, Medicare prescription drug plans (both Medicare Part D and Medicare Advantage plans that include drug coverage) may change the drugs they'll cover (the "formulary") for the following year. Or they'll change the conditions you'll have to meet to get coverage for certain drugs. If coverage will change for the worse for one or more of the drugs you regularly take, you may want to switch to another plan.
Costs. Each year, Medicare prescription drug plans (both Medicare Part D and Medicare Advantage plans with drug coverage) may raise their monthly premiums and co-payments for specific drugs. It's important to look at total costs of drugs and premiums. Because the market changes every year, you'll benefit by carefully evaluating your situation. A recent report by the consulting firm Avalere Health found premium increases for all top 10 prescription drug plans. However, AARP MedicareRx Preferred (the most popular plan) is only increasing by 57 cents per month nationally, from $39.85 to $40.42. Premiums for Advantage plans are also projected to go up slightly next year -- by 5 percent, or $1.47, on average, to $32.59 a month. It is to your benefit to have a plan that supports your specific medication needs, finances, and potential health situations.
How to Choose a Prescription Drug Plan and What to Consider
Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage vary from one state to another; the number of plans available to you depends on where you live. To find out what plans are available in your area, go to Medicare's official online service, called the Medicare Plan Finder. It can provide you with a list and contact information for all Part D drug plans and Medicare Advantage plans sold where you live.
To make your decision, you'll want to carefully follow the steps in the plan finder:
Step 1: List the medicines you regularly take. The system will guide you through the process.
Step 2: See which Medicare plans cover your medicines. Each Medicare Part D drug plan or Medicare Advantage plan with drug coverage includes some, but not all, prescription medicines. A plan pays nothing for drugs that aren't in its formulary, so find out which plans cover the drugs that you regularly take. The website will then give you options for looking at Advantage Plans with or without drug coverage and stand-alone drug plans. You can refine your search if you have special concerns.
Step 3: If you're considering a Medicare Advantage Plan, decide if that's as good for you as traditional Medicare. If you're now enrolled in traditional Medicare (Part A and B), and a Medicare Part D plan for drug coverage, but you're thinking about switching to a Medicare Advantage plan that provides both medical and drug coverage, review the pros and cons of switching to Medicare Advantage before you make any change.
Step 4: Compare plans. The website will then take you to plans for comparison. Choose three plans and click on the "plan comparison." Here you will see details about cost per drug, premiums and total costs. The grand total will tell you what you'll pay -- not including unexpected medicines -- for your drugs for the entire year under each plan.
Step 5: If you have high drug costs, see about "doughnut hole" coverage. If and when your total prescription drug costs for the year reach $2,840 (in 2013), most Part D plans (and a few Medicare Advantage plans) pay considerably less until those costs reach a yearly "catastrophic limit," which is $4,550 in your out-of-pocket costs (not total drug costs). This gap in coverage is known as the "doughnut hole."
Step 6: Find out if the plan puts restrictions on your regular medicines. Cost isn't the only consideration when choosing a drug plan. That's because even if a specific drug is included in a plan's formulary, the plan is permitted to put restrictions on it that could make it more difficult for you to get the drug covered. Information on the Medicare website identifies the restrictions on each drug for each plan. Check for the following:
Substituted drug. Plans can substitute a different, similar drug from the one your doctor prescribes. Find out if the plan does this with any of your drugs.
Tiered drugs. Part D plans may place drugs in tiered categories, charging higher co-payments for some tiers than for others.
Prior authorization. Plan D plans may require you, through your doctor, to get prior approval from the plan before it pays for a particular drug.
Step therapy. For a few drugs, a Part D plan may require you to try one or more other drugs -- "steps" -- before it covers the drug your doctor prescribes.
Step 7: See if your pharmacy participates in the plan. Most large pharmacy chains participate in most Medicare drug plans. But a local pharmacy where you regularly get your medicine might not participate in a particular plan that you're interested in. If this would be of concern to you, then before enrolling in a new plan, check with your convenient pharmacy to see if it participates in that plan.
Tip: Get free help sorting through Medicare drug plans. You can get free expert help sorting through Medicare drug plans from the State Health Insurance Assistance program (SHIP), in some states called the Health Insurance Counseling and Advocacy Program (HICAP). The counselors at a local SHIP or HICAP office have experience with the plans offered in that geographic area. Search for a SHIP counselor near you.