Dear Marci,

I recently got a letter in the mail saying my Part D premium is increasing next year. I found a different plan that covers my medications for a lower premium, but I’m not sure what to do next. How do I change my Part D plan now?

-Theodore (Selmer, TN)

Dear Theodore,

First, it’s helpful to know that you can only change your Part D plan during certain times of the year. Here are the enrollment periods you can use to change your coverage:

Fall Open Enrollment Period: This period runs from October 15 through December 7, with changes becoming effective January 1. It is sometimes also called the Annual Open Enrollment Period.
Medicare Advantage Open Enrollment Period: Only those with Medicare Advantage Plans can use this enrollment period. If you get prescription drug coverage through a Medicare Advantage Plan, you can also make changes to your coverage from January 1 through March 31.
Special Enrollment Period (SEP): Under certain circumstances, you may be eligible to use a SEP to make changes to Part D coverage. Here are some examples of SEPs:
You move out of your Part D plan’s service area.
You have or lose Extra Help.
You lose creditable drug coverage through no fault of your own.
We are currently in the Fall Open Enrollment Period, so you can change your Part D plan!

There are a few ways to enroll in a new plan:
Call 1-800-MEDICARE (1-800-633-4227).
Enroll online through Medicare Plan Finder.
Contact the plan directly to enroll.
Enroll through an insurance broker, if you work with one.
It is usually best to enroll through Medicare, since it’s helpful for Medicare to have the enrollment documentation in case any problems arise.

Once your new plan starts, you are automatically disenrolled from your old plan. You do not need to contact your old plan to disenroll.

I hope this helps!

-Marci

Dear Marci,

I have Original Medicare and a Part D plan. I’m considering changing my Part D plan this Medicare Open Enrollment Period. How can I compare Part D plans?

-Mina (Walla Walla, WA)

Dear Mina,

I’m glad to hear you’re comparing your Medicare coverage options this fall! Research shows that many people with Part D could lower their costs by shopping among plans each year. There could be another Part D plan in your area that covers the drugs you take with fewer restrictions or with lower costs, so it’s great that you are trying to compare plans.

I would recommend using Plan Finder to compare Part D plans. Medicare Plan Finder is an online tool at www.medicare.gov that can be used to compare stand-alone Part D plans or Medicare Advantage Plans. Plan Finder provides information about costs, which drugs are included on the plan’s formulary (list of covered drugs), and the star rating of the plan.

To use Plan Finder, follow these steps:

Go to www.medicare.gov and click on the button that says, “Find Plans Now.”
You can do a general search on the right side of the page, under the title “Continue without logging in” button. If you wish to save your drugs and pharmacy information, you can log into or create your Medicare account on the left side of the page.
Next, put in your zip code and use the drop-down list to choose whether you are looking for a Medicare Advantage or Part D plan. Make sure you click “Apply” and then click on “Start” to begin your search.
Then you can enter the drugs you take, choose the pharmacies you use, and indicate whether you are interested in a mail order option.
Plan Finder will display results for plans in your area. Note that a plan may not cover all of the drugs you take, but it may have alternatives on its formulary. Speak to your provider about whether these alternatives would be appropriate for you. Plan Finder also tells you if the plan has a deductible and how much the monthly premium is.

Initially, the plans will be sorted by “lowest drug + premium costs.” This is the closest estimate to what you may pay out of pocket for your Part D coverage for the year. You can select “Plan Details” to find out more specifics about coverage, including any coverage restrictions that might apply to your drugs.

Before enrolling, it is a good idea to call the plan directly to confirm any information you read on Plan Finder, as information may not be completely up to date. Here is a list of questions you can ask when calling a company about their prescription drug coverage. You can enroll in a plan online, by calling 1-800-MEDICARE, or by calling the plan directly.

Note that this year, there are some additional things that people who take insulin should consider when using the Plan Finder tool. Beginning in 2023, cost-sharing for insulin is capped at $35 per prescription. However, the Plan Finder tool does not reflect this price change. If you take insulin, do your Plan Finder search without your insulin included in your drug list. This will show you the lowest cost plans for your other medications. Then separately check with a plan to see if your insulin is on the plan’s formulary.

You can make as many changes as you want between October 15 and December 7, but only the last change you make will take effect on January 1. If you choose a plan and realize that it is the wrong plan after Fall Open Enrollment is over, in most cases you will not be able to change your coverage until the next Fall Open Enrollment Period. For this reason, it is important to carefully consider all of your options and take the time to research each plan in order to make a decision that fits your health care needs.

Good luck choosing the best Part D plan for your needs!

-Marci

Influenza (flu) viruses are detected year-round in the U.S. but are most common in the fall and winter. This year, the CDC recommends most people get the flu vaccine in September of October. There are many benefits to the flu shot, as the flu shot:

Can prevent you from getting sick with the flu
Has been shown to reduce severity of illness in people who get vaccinated but still get sick
Is an important preventive tool for people with certain chronic health conditions.
Helps protect pregnant people during and after pregnancy
Can be lifesaving in children
And, may also protect people around you.
Medicare covers one flu shot every flu season. Speak to your doctor if you have any questions about the flu vaccine.

Dear Marci,

I’ve had Original Medicare for a few years, but I’m planning to join a Medicare Advantage Plan during Fall Open Enrollment this year. How should I choose a Medicare Advantage Plan when there are so many options?

-Rhonda (Spring, TX)

Dear Rhonda,

It’s important to choose a Medicare Advantage Plan that fits your unique needs. Even if your friend or family member loves their Medicare Advantage Plan, it might not work well for you. There are numerous questions you can ask about a plan to determine if it would be a good fit for you, and you can find those below.

You may find it helpful to use Medicare’s Plan Finder tool to learn about the plans available to you. You can even call 1-800-MEDICARE (1-800-633-4227) to request their help with comparing these plans over the phone. Before enrolling in a plan, though, it is a good idea to call the plan directly to confirm what you have learned about it.

You can ask yourself the following questions before choosing a Medicare Advantage Plan:

How much are the premium, deductible, and coinsurance/copay amounts?
What is the annual maximum out-of-pocket cost for the plan? This amount may be high but can help protect you if you have expensive health care costs.
What service area does the plan cover?
Are my doctors and hospitals in the plan’s network?
What are the rules I have to follow to 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?
What is the plan’s star rating?
Medicare Advantage Plans usually include prescription drug coverage. You should also consider these questions when choosing a Medicare Advantage Plan to make sure that the prescription drug coverage that the plan offers meets your needs:
Does the plan cover all the medications I take?
Does the plan have restrictions on my drugs (i.e. 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 try a cheaper version of your drug before it will cover the 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? You pay the least if you used preferred network pharmacies.
Can I fill my prescriptions by mail order?
If I have retiree coverage, will the Medicare drug plan work with this coverage?
What is the plan’s star rating?
Remember that Fall Open Enrollment runs from October 15 through December 7 each year. During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare coverage. When you are ready to enroll in a new Medicare Advantage Plan, you can call 1-800-MEDICARE (800-633-4227) to make the change.

Finally, note that enrollment rules for Medigaps are different. If you later wish to switch from Medicare Advantage to Original Medicare with a Medigap, you may not have the right to purchase a Medigap. There are only a few specific protected times to purchase a Medigap under federal rules, but your state may offer additional rights. To determine whether you could make the switch back to Original Medicare with a Medigap, I would encourage you to reach out to your State Health Insurance Assistance Program (SHIP), as they will be familiar with the Medigap rules in your state.

-Marci

Dear Marci,

I just enrolled in Medicare a few months ago, and now I am hearing about Fall Open Enrollment coming up. What is Fall Open Enrollment, and what should do I do during this time?

-Patty (Providence Forge, VA)

Dear Patty,

What an important question! Fall Open Enrollment begins October 15 and ends December 7 each year. (You also might hear it be called Medicare’s Open Enrollment Period or Annual Election Period.) During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare Advantage and Part D coverage for next year. Even if you are happy with your current health and drug coverage, Fall Open Enrollment is the time to review what you have, compare it with other options, and make sure that your current coverage will meet your needs for the coming year.

You can make as many changes as you need to your Medicare coverage during Fall Open Enrollment. The changes you can make include:

Joining a new Medicare Advantage Plan
Joining a new Part D prescription drug plan
Switching from Original Medicare to a Medicare Advantage Plan
Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)
You should consider:
Your access to health care providers you want to see
Your access to preferred pharmacies
Your access to benefits and services you need
The total costs for insurance premiums, deductibles, and cost-sharing amounts
If you have Original Medicare, visit www.medicare.gov or read the 2023 Medicare & You handbook to learn about Medicare’s benefits for the upcoming year. You should review any increases to Original Medicare premiums, deductibles, and coinsurance charges.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). If you do not receive these notices by the end of September, contact your plan to request them. Review these notices for any changes in:
The plan’s costs
The plan’s benefits and coverage rules
The plan’s formulary (list of drugs your plan covers)
Additionally, make sure that your drugs will still be covered next year and that your providers and pharmacies are still in the plan’s network. If you are unhappy with any of your plan’s changes, you can enroll in a new plan. If you want assistance reviewing your options, contact your State Health Insurance Assistance Program (SHIP) for unbiased counseling.

Even if you are happy with your current Medicare coverage, consider other Medicare health and drug plan options in your area. For example, even if you do not plan to change your Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year; there could be another Part D plan in your area that covers the drugs you take with fewer restrictions and/or lower prices. You can use Medicare’s Plan Finder tool to compare your options and call your SHIP for assistance.

Best of luck to you this Fall Open Enrollment Period! Following the advice above, you can make sure your health coverage will meet your needs in 2023.

-Marci