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How to Manage Your Medicare Open Enrollment
If you are 65 years old older you know, or need to know, the deadline for “Open Enrollment,” is December 7. This means signing up or making changes to your current Medicare plan for your plan that will take effect on January 1, 2017.
Even if you’re happy with your current coverage, you might find something that’s a better fit for your budget or health needs. If you miss the Open Enrollment deadline, you’ll most likely have to wait a full year before you can make changes to your plan.
First, Some Definitions
Do you know the difference between Medicare Parts A, B, C and D?
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans)
A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. There can be cost savings with this plan but the choice of health care is not as great as other plans.
Medicare Part D (Prescription Drug Coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Tips for Medicare Plan Review
Here are five important things every Medicare beneficiary can do to get into the Medicare Open Enrollment routine each year:
1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network.
2. Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Is your new medication covered by your current plan? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change.
3. Find out if you qualify for help paying for your Medicare. Learn about programs in your state to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and copayments, and Medicare prescription drug coverage costs. You can do this by visiting Medicare.gov or making an appointment with a local State Health Insurance Assistance Program (SHIP) counselor.
4. Shop for plans that meet your needs and fit your budget. Starting each October, you can use Medicare’s plan finder tool at Medicare.gov/find-a-plan to see what plans are offered in your area. A new plan may:
• Cost less
• Cover your drugs
• Let you go to the providers you want, like your doctor or pharmacy
If you find your current coverage still meets your needs, then you’re done. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.
5. Check your plan’s Star Rating before you enroll. The Medicare Plan Finder is up-to-date with the Star Ratings for Medicare health and prescription drug plans. Plans are given an overall quality rating on a one to five star scale, with one star representing poor performance and five stars representing excellent performance. Star Ratings can be used to compare the quality of health and drug plans being offered.
Medicare Part D Prescription Drug Coverage – What You Need to Know
According to John Lee, Senior Director of Medicare at Walgreens, “Although more than 55 million Americans are eligible to enroll in Medicare Advantage or prescription drug plans, many of them do not actually take the time each year to review their options.
“Health insurance is complicated. That goes for Medicare Part D prescription drug coverage, too, as the cost of prescription drugs remains a top concern among many of us. A recent survey by Walgreens showed that in order to manage prescription drug costs, some people have delayed filling a current prescription or occasionally skipped prescribed doses to stretch medication. This is a real concern, as it can pose significant health risks, so it’s vital to evaluate your medical situation and have a plan that best fits our needs.”
The findings from the survey found that even though prescription drug costs are among the top concerns for Medicare beneficiaries, approximately one out of every five beneficiaries lacks a good understanding of their own insurance plan.
Roughly the same percentage falsely believes that all pharmacies charge the same copay, and one-third of respondents didn’t know they can switch pharmacies at any time, including outside of the enrollment period. This survey reinforces the need to educate beneficiaries about how plans and coverage can and do change from year to year.
Recommendations from Walgreens
“I encourage you to make the most of your benefits and find potential cost savings for your prescription medications when renewing your Part D coverage,” Lee said. “Here are three easy steps to get started.”
Look at how plans cover your specific prescription drugs
How specific drugs are covered by insurance can vary from one plan to another, so it’s important to review your personal situation and the list of medications under any plan you are evaluating. It’s also important to pay attention to the “tier” your drugs fall into, which can determine how much of the cost you pay. Typically, generic drugs fall into tier 1, and preferred brands, non-preferred brands and specialty drugs fall into higher tiers.
Look at premiums, deductibles and copays
You can better forecast your total out-of-pocket costs if you look at these three features, which can vary under Medicare Part D or Medicare Advantage plans. The premium is the monthly fee you pay to be insured. Deductibles are the amounts you’ll pay out-of-pocket for your prescription medications before your Part D plan begins to pay its share. Copays are the portion of drug costs for which you are responsible after your deductible (if any) is met.
Verify whether your plan has preferred pharmacies
Many plans have a preferred pharmacy (also known as “preferred cost share”) network. By filling prescriptions at a preferred pharmacy in your drug plan, for the exact same drug, you can save on the cost of your prescription copays. For example, Walgreens is in the preferred pharmacy network for many of the largest Medicare sponsors, including Aetna, Cigna, EnvisionRx, Express Scripts, First Health, Humana, SilverScript and UnitedHealthcare, and many others across the country, including several Blue Cross/Blue Shield plans that use Prime Therapeutics as their pharmacy benefit manager.
Effective January 2017, some of these plans offer copays as low as $0 for generic medications filled at a preferred pharmacy, while filling at a non-preferred pharmacy could cost you $3, $5 or even $10 for the same drug.
For more information, call 1-800-MEDICARE (1-800-633-4227) and say “Agent.” TTY users should call 1-877-486-2048. Help is available 24 hours a day, including weekends. If you need help in a language other than English or Spanish, let the customer service representative know the language. You can also visit a local SHIP counselor, who can provide free, one-on-one, non-biased Medicare assistance. Find one at medicare.gov/contacts/. Additional information about Medicare is available on the Medicare Facebook page and by following @MedicareGov on Twitter.
John Lee, Senior Director of Medicare at Walgreens, is the business unit leader overseeing the Walgreens Medicare segment, focused on driving company results with Medicare members and the senior segment more broadly.
