According to the Kaiser Family Foundation, 3 out of 4 Medicare recipients (48 million) have a Medicare Part D Plan. This includes stand-alone Medicare Part D Plans, as well as prescription drug plans that are coupled with a Medicare Advantage plan (MA-PD). The split between stand-alone Part D plans and MA-PD plans is roughly 50/50 at the moment, whereby, the Medicare Advantage Prescription Drug Plans are becoming popular to the cheaper premiums and copayments.
Managing Prescriptions, Refills, Out-of-pocket costs, and Insurance Coverage is Tough for Everyone
Any person who visits a pharmacy on regular basis knows, the cost of medications and consistent accessibility to refills is a frustrating and everchanging riddle. That car in front of you at Walgreens may be just like you — jumping through hoops put in place by Medicare carriers just to get their cardiovascular medications like Lisinopril, Simvastatin, Atorvastatin; or perhaps a gastrointestinal medication like Omeprazole and Nexium; or arthritis treatments like Celebrex. Many times, what seems like a long wait in line is actually someone just like you working pre-approvals with that carrier, or seeking to understand or resolve a surprise spike in the cost of their prescription since their last visit.
Don’t Be a Victim to Your Medicare Prescription Drug Plan and Overpay for Poor Coverage or Service
If Medicare prescription drug plans (Medicare Part D) are always changing, it’s imperative for Medicare recipients and informed retirees to understand the rules, key Medicare enrollment dates, and maintain awareness for changes in Medicare and opportunities for saving money with the best Part D plans.
Consult with a Qualified Licensed Agent About Different Medicare Prescription Drug Plan Options
The specific needs of Medicare beneficiaries change. TrustMedicare.com recommends maintaining an organized list of medications including prescription drugs and over-the-counter medications and treatments, as well as frequency of use and out-of-pocket costs over the past year. To truly understand the cost and coverage benefit of switching between one Part D plan over another Part D or Medicare Plan, you must be able to clearly compare apples-to-apples. Moreover, make notes about specific medications including the challenges of getting refills, availability of generics or your preference for a name-brand prescription drug.
Compare Different Medicare Part D Prescription Drug Plans Regularly
TrustMedicare.com recommends that every retiree and Medicare recipient shop and compare different plans at least once a year – generally in the Fall. You don’t have to wait though; talk to an agent if you’re frustrated with your current plan, or seek to understand how to navigate the healthcare system in an easier way with the plan you have. You don’t always need to switch Medicare plans to find satisfaction. The Kaiser Family Foundation also reports there were 996 Medicare Part D stand-alone prescription drug plans registered with Medicare and available to beneficiaries – subject to specific qualifications and coverage areas of course. Bottom-line: Medicare Part D customers have choices. The states with the largest selection of plans are California, Arizona, Texas, Alabama, Georgia, Tennessee, and Pennsylvania all offer more than 30 different stand-alone Part D plan. Even states with limited selection like Colorado, Louisiana, Vermont, and Maryland have more than 25 different plans. Talk to an experienced licensed agent and compare Medicare drug plans and the optimal time for switching.
Medicare Part D Carriers Update Plans Frequently
The prescription drug plan that’s affordable and optimal for a senior in the Fall, may become a nightmare later in the year relative to the affordability of Part D premiums, plan deductibles, coinsurance, and copayments. Sometimes the limited access to known alternative generics, and changing health and prescription needs becomes overwhelming as well. Regardless, changing Medicare prescription drug plans is subject to rules and important dates and deadlines. In 2021, the average monthly premium for a Part D Prescription Drug Plan was just over $33.00. Do you know if you’re paying too much? Talk to an agent discuss your current Part D plan against your health needs and the affordability and coverage available from other Medicare carriers.
Here are the most common situations and important information addressing “when” and “how” seniors can change their prescription drug plans.
When Most Seniors Enroll: Turning 65 and Enrolling for Medicare Drug Coverage During the 7-Month IEP
The most common time to compare different Medicare drug plans is during Medicare’s Initial Enrollment Period (IEP) which starts 3 months before your 65th birthday, and continues 3 months after and includes your actual birthday month.
Early-bird advantage tip: For seniors who enroll in a drug plan in the first three months of their respective IEP, the Medicare drug plan will start on the first day of the Birthday month. For those who enroll during IEP months 4, 5, 6, or 7, the drug plan coverage will start on the first day of the very next month – after the actual enrollment.
When Most Seniors Change Medicare Drug Plans: Medicare (AEP) Annual Election Period
If you’re unhappy with your drug plan, you may be able to change plans during the Medicare Annual Election Period, between October 15th and December 7th. AEP dates are the same every year. Medicare recipients need to know that coverage for all new drug plans will kick in on January 1 – weeks after the enrolling.
Pay attention to your Part D Drug Plan’s coverage options and any substantial impacts to your needs. If your drug plan changes coverage options – including approved drugs, you will receive an Annual Notice of Change that details all changes to the plan’s coverage in the upcoming year.
Special Circumstances Forcing a Change of Medicare Drug Plans
Medicare gives seniors flexibility to update drug plans in a number of common circumstances where there simply aren’t any other options which include the following:
- Moving outside of a prescription drug plan’s service area qualifies for a plan change.
- If you don’t currently have a Medicare Drug Plan; however you have prescription drug coverage through alternative options such as an actively working spouses group heath plan – and you lose that “credible drug coverage”, you may qualify to update your coverage.
- Nursing home change: Seniors who are entering a nursing home or leaving a nursing home, may need to review and update their prescription drug coverage.