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ALL YOU NEED TO KNOW ABOUT MED D OPEN ENROLLMENT



Are you 65 years of age or older and looking for a new or updated Medicare Part D plan? Are you unsure of where to start or how to review your plan? Maybe you’ve heard of a Part D plan but are unsure of what it is? A Medicare Part D plan covers prescription drug costs, both generic and brand name, for those 65 years or older. These plans can — and should —be reviewed each year during the open enrollment period, which takes place every year from October 15 to December 7. We’ve put together some basic information here, and our team at your local pharmacy can answer any questions you may have about choosing the perfect plan to fit your needs.


What is Open Enrollment?

Open enrollment is a set time frame, in this instance for Medicare Part D, where you can join, switch, or drop a plan depending on your eligibility. The Open Enrollment period for Medicare Part D beings on October 15 and lasts until December 7 each year. During this time, you can join, switch, or drop a plan, with coverage beginning on January 1 of the following year. You can make as many changes as you would like during those weeks, but it’s recommended that you make changes as few times as needed to avoid any enrollment problems.


When am I Eligible for Medicare Part D?

Anyone who is 65 or older is eligible for Medicare Part D, but Open Enrollment is only October 15 – December 7 to go into effect in the new year…so what happens when you turn 65? There is a different process for newly eligible, called the Initial Enrollment Period (IEP). That period begins 3 months before you turn 65 and ends 3 months after you turn 65 or begins 3 months before your 25th month of getting Social Security or Railroad Retirement Board (RRB) disability benefits and 3 months after that time. That timeframe may or may not overlap with the Open Enrollment period.


In order to enroll in a Medicare Part D drug plan plan, you must already have Medicare Part A and/or Medicare Part B as well as you must be a United States citizen or lawfully present in the United States.


What Can I do During Open Enrollment Period?

During the open enrollment period of October 15 – December 7, you can do any of the following:

  • Change from Original Medicare to a Medicare Advantage Plan

  • Change from a Medicare Advantage Plan back to Original Medicare

  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan

  • switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage

  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage

  • Enroll in a Medicare Part D plan if you didn’t enroll when you first became eligible for Medicare

  • Switch from one Medicare drug plan to another Medicare drug plan

  • Drop Medicare drug coverage completely.

If you have any questions about how to do any of these options, stop into your local pharmacy or give us a call. We have partnered with a local advisor who is here to help you evaluate all your plan options to ensure you choose the coverage right for your needs.




Four Signs You May Want to Change Your Medicare Part D Plan

Your health changes overtime, and that can mean that your medication needs change, too. Even if everything on your side stays the same, that doesn’t mean that the plan you are on has stayed the same. Each year, it’s a good idea to review your plan and see if it still fits your needs. Here are some signs to be aware of when considering changing your plan.


Plan formularies change from year to year.

Part D plans have formulary to help place various medications into different tiers. The lower the tier, the lower the copay — and on the flip side, the higher the tier, the higher the out-of-pocket costs. These tiers can change from year to year, so it’s important to review what medications you are taking and what tiers they fall under. Your pharmacist can help you review your medications and figure out what tier you are at with each of them.


Your medication needs have changed.

If you are taking new medications, there’s a chance that your current plan offers great coverage. But there’s also a chance that a different plan you can choose during Open Enrollment overs a better deal on your new medication regimen. For example, let’s say you are paying a high premium for a plan that places your medications on a low tier. If you switch to a generic, cheaper version of that medication, you may have a lower premium. Or, if your current plan has placed your medication in a high tier, you can see if there’s a different plan that has the same medication under a low tier.


Pharmacy networks change each year.

Most Part D plans require enrollees to fill prescription at in-network pharmacies, and the list of pharmacies in and out of network often changes each year, too. If you use an out-of-network pharmacy, you may end up paying full price for the medication. That isn’t always the case, so it’s important to review your medications and plan with your pharmacy and see what the cost would end up being. Even if you choose an out-of-network plan for your pharmacy, the team may be able to find cash savings for you without forcing you to switch pharmacies.


You’re paying a high premium for a plan you don’t use often.

Plans are there to help cover costs, both expected and unexpected, and many people try to plan for the unexpected. But realistically, you may not actually need a plan that you picked the previous year. If you are on a Part D plan that has more coverage than you ended up needing, that means you’re paying a higher premium without the cost savings you may have expected.


Once you have reviewed your current plan and see that you may want to make changes based on those four tips, you will want to search for a plan that fits whatever your needs may be.


Sources:

https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

https://www.medicareresources.org/medicare-open-enrollment/#

https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-enrollment/changing-part-d-plans

https://www.healthmarkets.com/resources/medicare/when-is-the-medicare-part-d-open-enrollment/

https://www.medicareresources.org/medicare-benefits/four-signs-you-need-a-new-medicare-part-d-plan/#formulary

https://www.nerdwallet.com/article/insurance/medicare/what-is-medicare

https://www.medicareresources.org/states/

https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage

https://blog.medicaresolutions.com/open-enrollment-checklist/

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