With Fall Open Enrollment coming up, I am thinking about changing my Medicare coverage. I might keep Original Medicare and enroll in a new Part D prescription drug plan, or I might enroll in a Medicare Advantage Plan with prescription drug coverage. What factors should I consider when I am looking at different plans?
-Eva (Topeka, KS)
Dear Eva,
Fall Open Enrollment, which runs from October 15 through December 7, is the right time to review your current coverage, compare it with other options, and possibly make changes. The last change you make during Fall Open Enrollment will take effect on January 1, 2019. To avoid enrollment problems, it is best to call 1-800-MEDICARE when making changes to your health and drug coverage.
Here are some questions to ask about any Medicare Advantage Plan that you are considering enrolling in:
How much are the premium, deductible, and coinsurance/ copay amounts?
What is the annual maximum out-of-pocket cost for the plan? This amount might be high, but can help protect you if you have expensive health care costs.
What service area does this plan cover?
Are my doctors and hospitals in the plan’s network?
What are the rules I have to follow t access health care services and my drugs?
Does the plan cover additional health care benefits that are not covered by Original Medicare?
How will this plan affect any additional coverage I may have?
Ask yourself these questions before choosing a Part D prescription drug plan or a Medicare Advantage Plan with prescription drug coverage:
Does the plan cover all the medications I take?
Does the plan have restrictions on my drugs (like prior authorization, step therapy or quantity limits)?
Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug
Step therapy means that your plan requires you to trey a cheaper version of the drug before it will cover a more expensive one.
Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
How much will I pay for monthly premiums and the annual deductible?
How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
Is my pharmacy in the plan’s preferred network?
Can I fill my prescriptions by mail order?
If I have retiree coverage, will the Medicare drug plan work with this coverage?
For both Medicare Advantage Plans and Part D prescription drug plans, you may also want to consider a plan’s star rating. Star ratings are quality ratings that provide a measure of a plan’s performance. Medicare scores plans in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest.
Keep in mind that a plan’s star rating is only one factor to review when comparing plans in your area. Even though a plan has a high star rating, it may not be right for you. It is important to see whether the plan covers the health services and drugs you need and works with the pharmacies you use before considering its star rating. Also, note that the star ratings in the Medicare & You handbook are not necessarily the most recent. For the most up-to-date, comprehensive star ratings, you should call 1-800-MEDICARE or use the online Plan Finder tool at www.medicare.gov.
You may also find it helpful to use Medicare’s Plan Finder tool, which gives you a list of Medicare Advantage and Part D plans, the drugs they cover, and their estimated costs for the year. You can access Plan Finder by going online at www.medicare.gov or calling 1-800-MEDICARE.