Tips Now For Medicare Part D
Medicare Part D Enrollment: A Comprehensive Guide
By Becky Rabbitt, PharmD, RPh
Medicare enrollment can be a daunting process for both seniors and their caregivers. There’s a lot of information to sift through, predictions to make, and the added stresses of a limited enrollment period. However, choosing a plan can have major financial implications; making the right choice can provide you with significant cost-savings over the long term. Even if you are enrolled in the perfect plan last year, plans change every year, so it is important to pay attention to changes and re-evaluate your coverage before choosing to re-enroll.
Medicare Part D enrollment runs from October 15th through December 7th – Now is the time to begin researching plans and making your selections. Waiting until the last minute to research and select a plan can put you at risk for making poor decisions. Neglecting to enroll during the Initial Enrollment Period, if you do not already have coverage, will result in a permanent late enrollment penalty that you will need to pay in addition to your premium for as long as you have coverage.
Finding the Medicare Plan That’s Right for You
There are a number of factors to consider when selecting a Medicare Part D plan. Below are some tips for simplifying the selection process:
Understand the Different Medicare Options: Original Medicare is comprised of Medicare Part A for hospital care, Medicare Part B for doctors’ visits, and Medicare Part D for prescription medication coverage. Original Medicare may be augmented with a supplemental plan, such as Medigap. Medicare Advantage (also known as Medicare Part C) provides a combination of Parts A and B, and often includes Part D coverage as well. For the purposes of this article, we will focus on Medicare Part D.
Search for Stars: Evaluate Star Ratings for the plans you are considering. The Centers for Medicare & Medicaid Services (CMS) ranks each plan based on factors such as customer service, member complaints, member experience and patient safety. Plans are ranked each year on a scale from 1-5 stars, with five being the highest. In general, you should be searching for plans with more than three stars, as these are the highest quality plans.
Calculate the Plan’s Total Cost: A plan’s monthly premium is just one item contributing to your total costs; it’s important to also consider your deductible, copayments and/or co-insurance when comparing plans. Plans with lower premiums may have a significantly higher deductible or copayments, which could cost you more in the longer-term. Looking at your medication needs and comparing plans based on total cost will give you a better sense of a plan’s total value.
Consider Your Future Health: The list of drugs covered by your plan, known as a formulary, can change each year. The drug you take today may be replaced with a generic, or moved to a higher tier to keep premiums and deductibles down, so it is important to make sure that the plan you are considering will still cover the medications you take today. Because your health may change as well over the course of a year, you should also look for plans that cover drugs you might expect to need in the future.
Access to pharmacists: Pharmacists play an important role in your health and are an excellent resource for helping to manage your medications. Pharmacists can help you find lower-cost alternatives for your medications, answer questions about your medications, and provide support if you are experiencing side effects or need additional support in managing your condition. Look for a plan that offers 24/7 access to pharmacists from the privacy of your home. If you are taking a specialty medication, such as one to treat rheumatoid arthritis or multiple sclerosis, look for a plan that has a specialty pharmacy as well.
Network Options = Additional Savings: Plans that offer a large network of preferred pharmacies can offer additional savings for your medication. Make sure the plan you choose offers this cost-saving feature. If you travel often or move seasonally, ensure there are in-network options where you go. Some plans even offer a home delivery pharmacy option to safely shipping your medications directly to your home.
Talk to the Right People: Remember to rely on experts and credible websites. Unfortunately, there is a lot of misinformation out there that you’ll have to avoid. Make sure that the people you’ll be interacting with at your selected plan(s) are available and knowledgeable. You should also consider contacting plan advisors, insurance agents or brokers who have experience with these plans. There are also many state level programs that can help you with your decision. Talking directly to advisors at the plan can give great insight into their customer service levels and satisfaction.
Once you’ve selected a Medicare plan and enrolled, you won’t have to go through the process again for another full year. It’s always good to remember, though, that by next year, both your situation and the available plans may have changed. With people living longer than ever, it’s not a question of “if” you might develop a chronic condition or need medical care, it’s a matter of “when.” And since plans change year-over-year, a plan that makes sense for you right now may be less ideal next year, or another plan may have improved to the point where it’s a better option for you.
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