Fall is in the air! Time for pumpkin spiced treats, watching football, getting out our winter gear, putting on our studded tires, and for Medicare beneficiaries, it is time to review our prescription drug coverage. Known by a number of titles such as the Fall Open Enrollment period, the Part D Open Enrollment, or Medicare’s Open Enrollment, each autumn between October 15 and December 7, Medicare offers the opportunity for Medicare beneficiaries to make changes to their coverage. These changes can include: enrolling in a Medicare prescription drug plan if you have not yet done so or joining a Medicare Advantage Plan, (there are no Medicare Advantage plans available in Alaska at this time). You can also choose to change your prescription drug plan if you find a plan that better meets your needs.
If you have Original Medicare, Part A and/or Part B, you can get prescription drug coverage (Part D). Unlike Part A and Part B, which are overseen by the Centers for Medicare and Medicaid Services (CMS), CMS contracts with private companies who offer Part D plans. These plans serve a specific service area. Currently in Alaska there are 18 plans available for 2017. Each plan has a formulary, the list of medications the plan will cover. Plans must cover a number of drugs under each therapeutic category, however each plan gets to choose the particular medications they will cover. Each plan will charge a premium, may require a deductible, and there will generally be co-pays or co-insurance. The plan that is best for each beneficiary is driven by the specific medications they take and which pharmacies they like to use.
Each year these companies can make changes to the plans they are offering. Changes can include the price of the premium, which is the amount you pay to belong to the plan; the amount of the deductible, which is the amount that you pay before the plan begins to work for you. Medicare does place a maximum or cap on the annual deductible. The co-pays or co-insurance can vary from plan to plan — this is the amount you pay at the pharmacy after the plan has paid their part. Plans can impose requirements such as prior-authorization for covering certain medications quantity limits or limiting the amount that the plan will pay of any certain medication, and step therapy, requiring the beneficiary try a less expensive medication for up to 90 days before paying for a more expensive drug.
The plans may change what particular medications will be covered each year and which pharmacies will be in their network as well as which pharmacies will be designated “preferred” pharmacies. Preferred status pharmacies generally will save the beneficiary money because they agree to give a particular Part D plan a larger discount than other pharmacies. All these changes can mean that the plan that was your best choice this year may not be your top choice for next year. You can make changes more than once during open enrollment, but the last change that you make will take effect on Jan. 1, 2018.
This may seem overwhelming and there are things you can do to prepare for the Open Enrollment period. Beneficiaries should watch for notices from their Part D plan. The Annual Notice of Change letter and the Evidence of Coverage publication will let you know what changes are being made to your current plan. You can also review your “2018 Medicare & You Handbook,” which will include information about all of the drug plans that will be offered for 2018. This booklet usually arrives in September of each year.
If you like to use the computer, you can use the Medicare Plan Finder tool available at http://www.medicare.gov. The 2018 plans will be available for review after Oct. 1, but you cannot enroll until Oct. 15.
Yes, it is fall and almost time for Open Enrollment Season, but do not be dismayed! There is help available. If you would like assistance in reviewing and comparing plans you can contact the State of Alaska’s Medicare Information Office at 1-800-478-6065, call or make an appointment with a local Medicare counselor, or contact 1-800-MEDICARE .
Nila Morgan is a Master Certified Medicare Counselor and Medicare Fraud Education Coordinator who works at the Anchorage Senior Activity Center.
Nila Morgan is a Certified Medicare Counselor who works at the Anchorage Senior Activity Center.
