With Medicare open enrollment here, now is the time participants can change plans or people who are newly eligible for Medicare can enroll. There are several important considerations for anyone planning to make a change this fall.

Enrollment Dates

Open enrollment lasts from October 15 through December 7. These dates are the same every year. When a person enrolls in a plan or makes a change, the new plan is effective January 1. For most situations, the open enrollment period is the only time when a person can choose an Advantage plan or a Part D plan. People who have an Advantage plan and want to switch back to Original Medicare should also enroll in a Part D prescription drug coverage plan. Medigap is also helpful to have with Original Medicare to cover costs. However, they are limited in availability during open enrollment depending on geographic location.

Review Your Coverage

Everyone should review their Medicare coverage annually. A review is not just important for people who are unsatisfied with their current coverage. Every person should review their current coverage, find out what the upcoming year’s changes are and make an educated decision. If health issues change during the year or are expected to change, one plan may be better than the existing coverage.

Understanding Medicare Part D

Members of Part D and Advantage plans receive annual notices outlining the various changes to coverage within the plan. For example, a Part D plan covering one type of prescription drug may stop covering it during the next year. For people who rely on that drug, a prescription plan switch may be necessary. Research suggests that people who compare Part D plans can save themselves hundreds of dollars by doing so every year. Always check with various plans in the area to see which ones have less restrictions and cover more drugs.

There are two ways to get prescription drug coverage through Medicare. One way is with Part C coverage, which is available through a PPO or HMO plan. These plans offer the same benefits as Part A and Part B coverage as well. Part D coverage is used separately from Original Medicare or PFFS plans and a few other types. A Part D plan only covers prescription drugs. Participants can enroll in Part D plans by mail, by phone or online. If a person is enrolled in a Medicare Advantage plan or Part C and enrolls in Part D, that individual will be removed from Part C coverage and returned to Original Medicare.

What Part D Covers

Every prescription drug plan from Medicare has a list of covered drugs. Prescription drugs are placed in separate tiers based on their prices. Low-tier drugs usually cost less than drugs in higher tiers. There may be instances where a prescriber insists that a patient use a high-tier drug instead of a low-tier alternative. If this is the case, it may be possible to ask for an exception and have a lower copay obligation. Formularies may change each year based on Medicare’s guidelines. When changes involve a currently used drug, the plan must provide written notice of the change 60 days before the change takes place. Notification may be made by direct contact or when a patient requests a refill of the affected drug.

Getting Enrollment Right for You

For those who are newly eligible to enroll in Medicare, it is important to take the time to research all options. Enrolling may seem confusing with all of the information available. For more information about changing a plan or enrolling for the first time, contact our employee benefit specialists today.