Time to Start Shopping Your Medicare Part D Plan
As is the case every year, traditional Medicare beneficiaries or their caregivers should shop Part D prescription plans during the Oct 15 – Dec 7 open enrollment period and also read the Annual Notice of Change that your insurer sends to you.
While you can’t enroll in a new plan until October 15, you can start to preview 2022 drug plans by clicking here and so you can start shopping now.
Logging into your Medicare account allows you to:
- Build your prescription drug list (formulary) to help you compare plans.
- Compare benefits and costs in your current plan to other plans available in your area.
- See prices based on any help you get with prescription drug costs.
- Easily find and save pharmacies in your area.
Remember: When comparing plans, look at the estimated “Yearly Drug & Premium Cost.” Part D premiums are often the smallest part of your total cost so a plan with the lowest premium may not always provide the lowest total cost to you.
Plans can change their formularies and drug costs every year. They can also add “prior-authorization” or “pre-certification”, which means that you need the plan’s approval before covering your current medications starting in January. Check to see whether your medications are still covered and in the same tier and at what cost. Also check to confirm if your pharmacy is still “preferred” or if another pharmacy nearby may be a better choice.
Even without major coverage changes to your existing plan, new and different plans may be available in your area so it still pays to shop around. If you find a plan that offers generic drugs without co-pays, and those offerings apply to your medications, then this could save you a lot of money. Generics comprise almost 90% of prescriptions written today!
Using Medicare’s plan finder tool (rather than a third party’s tool) when you enroll allows you to hold Medicare and your Part D plan accountable if any information turns out to be inaccurate. You should be able to change plans during the year if that turns out to be the case and you can back it up with proof that a plan gave you incorrect information when you were selecting it.
If you are not comfortable using the computer and the internet, then the next best way to select a Plan D is simply to call Medicare at 800-633-4227. Unlike Social Security, Medicare is open 24/7 and the best time to call is late at night when volumes are low and you are likely to get better attention. In order to accomplish the same result available through the online tool, you need to have information on your medications, dosages, and pharmacy handy so that they can help you find the best plan.
If you can’t find a plan that covers all your medications, then you may be able to work with your doctor to get your existing plan (where they have changed a medication to require pre-authorization) to cover the drug anyway. Keep any correspondence from your Part D insurer that shows they’ve approved the drug for this year as evidence to submit to support your case. Also, if your plan benefit has changed, then your existing insurer generally must offer you a 90-day filling of your current medications (known as “transition fill”).
If you want to review the monthly premium for drug plans and Income Related Monthly Adjustment Amounts (IRMAA), the yearly Part D deductible amount, initial copayments/coinsurance, costs in the coverage gap and catastrophic coverage, then please click here.
Lastly, if you have a Medicare Advantage Plan, then that same insurer provides your health and hospital benefits too. You may consider changing your Medicare Advantage plan during open enrollment if your plan’s Part D list of Medicare approved prescription drugs (“formulary”) for next year would limit your ability to continue taking your current prescriptions. Just make sure that the replacement plan includes your current health providers too!
The difference between a plan that meets your needs and one that doesn’t can potentially save thousands of dollars each year, which adds up over the course of a normal retirement today. The key to realizing any savings is simply to avoid being complacent and, instead, be a savvy shopper.
Be sure to focus on the lowest cost plan in terms of your “total out-of-pocket” expense (including co-pays and co-insurance and not just the premium ) and on plans that have at least a three star rating (four is even better). If you need help, then ask – a friend, neighbor, family member – or an advocate that you can access through your senior center or social services office.
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