Should I review my Medicare Part D plan choice every year?

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It is very important that you review your drug plan every year. Medicare private drug plans can change their costs and the list of drugs that they cover every year.

Most people can only change Medicare drug plans during Fall Open Enrollment (sometimes called the Annual Coordinated Election Period), which runs from October 15 to December 7 each year.

You may also be able to change your Part D plan during the Medicare Advantage Disenrollment Period (MADP) if you have a Medicare Advantage plan. The MADP occurs every year, from January 1 to February 14. If you have a Medicare Advantage plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. For example, if you switched from a Medicare Advantage plan to Original Medicare and a stand-alone prescription drug plan in February, your new coverage would begin March 1.

Even if you are satisfied with your current Medicare coverage, you should check if there is another plan in your area that offers better coverage at a lower price. Look at other Medicare options in your area and compare them with your present coverage to see which plan will best suit your needs in the upcoming year. Research shows that people with Part D plans could lower their costs by shopping among plans each year. For example, another Part D plan in your area may cover the drugs you take with fewer restrictions and charge you less.

When choosing a Medicare private drug plan, make sure to look at all the costs, not just the premium. Your costs throughout the year will depend on what drugs you take, whether your plan covers them, and whether there are any coverage restrictions. Another plan may have lower copays, cover more of your drugs, have fewer restrictions or offer some coverage during the coverage gap.

If you are considering joining a Medicare Advantage planp to get drug coverage, remember that you will get all of your Medicare benefits from that plan. Look beyond the drug coverage; make sure the plan covers you to go to the doctors, hospitals and pharmacies you prefer to use at a cost you can afford.

How to review your current plan:

  • Review your plan’s Annual Notice of Change. Each fall, your Medicare private drug plan will send you a notice explaining how your plan’s coverage and costs are changing for the next year. Your plan must send you this notice before September 30th. If you do not receive it by this time, call and ask for it
  • Find out whether your drugs will be covered next year. You should call your plan and ask, as plans are only required to send you a shortened list of covered drugs (formulary). Also find out if your copays will change and whether the plan is adding any coverage restrictions that will require your doctor to ask for special permission before the plan will cover your drugs.

If your doctor had to make a special request for your plan to cover a drug for you this year (such as a prior authorization or exception request), and you will need the same medication next year, call your plan and find out what you must do to make sure your plan keeps covering your drug. Your doctor may have to make a new request, and he may be able to do so before the end of this year to ensure your drug will still be covered next year.

If your plan will no longer cover a drug you are taking, your plan must help you complete the exception process or change to another formulary drug before the end of year.  If the plan fails to do this, your plan must provide you a 30-day supply of the drug during the first 90 days of the year, and send you a notice explaining that the prescription is temporary and that you must file an exception to continue taking it.

Once you have reviewed your current plan, see what other options are available in your area. You can do this by either calling 800-MEDICARE or by going online and visiting www.medicare.gov/find-a-plan. Keep in mind that if you would like to make changes to your Medicare drug coverage, it may be best to do so by calling 800-MEDICARE in order to avoid enrollment errors. 


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Changing your Medicare Part D plan

Changing your Medicare Advantage plan

Drugs that are excluded from Medicare coverage

Comparing Medicare Part D plans

 
LINKS
Medicare.gov - Drug Plan Comparison

 
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