Life After 50 Expo

Dear Marci,

My Part D premium is increasing a lot in 2024, so I want to use Fall Open Enrollment to sign up for a different Part D plan. How should I choose a new Part D plan?

-Louise (Fort Lauderdale, FL)

Dear Louise,

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, drug coverage, 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.” 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 then choose what kind of plan you are looking for—a Medicare Advantage Plan, a Medicare drug plan, or a Medigap policy.
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 the drugs you take, but it may cover alternatives. 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 (633-4227), or by calling the plan directly.

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.

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

-Marci

Dear Marci,

I enrolled in Medicare earlier this year. My sister told me that Fall Open Enrollment for Medicare is coming up. What is Fall Open Enrollment, and what do I need to do during this time?

-Abigail (Redding, CA)

Dear Abigail,

Fall Open Enrollment runs from October 15 through December 7 each year. This period is also sometimes called the Annual Election Period. During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare coverage. Even if you’re 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 still meets 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)

Regardless of how you receive your Medicare coverage, 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 2024 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). 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)

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 individualized 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’s 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.

-Marci

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Dear Marci,

I called my pharmacy to schedule an appointment to get my flu vaccine. They told me I could also schedule my RSV vaccine, which was news to me. Does Medicare cover this?

-Matteo (St. Louis, MO)

Dear Matteo,

What a timely question! Earlier this year, the Food and Drug Administration (FDA) approved the RSV vaccine. According to the Centers for Disease Control and Prevention, the RSV vaccine can help prevent lower respiratory tract disease caused by respiratory syncytial virus (RSV). RSV season varies from year to year, but usually starts in the fall and peaks in the winter. RSV can affect people of all ages but may be especially serious for infants and older adults.

Medicare Part D covers the RSV vaccine if it’s recommended for you by the Advisory Committee on Immunization Practices (ACIP), a government agency that gives advice about who should get certain vaccines. At this time, the RSV vaccine is recommended for adults over the age of 60.

There should be no cost to you to get this vaccine. This means your pharmacy shouldn’t charge you a copay or deductible to get the RSV vaccine. If you have Medicare Part D, it should be free to you.

If you have Medicare Part D and your doctor or pharmacy tries to charge you for the RSV vaccine, you should call 1-800-MEDICARE (1-800-633-4227) for help.

If you have non-Medicare drug coverage (like drug coverage from an employer or union), you should check to see its coverage rules for the RSV vaccine. Because this is a newer vaccine, it may not be listed on an insurance plan’s list of covered drugs yet, so you should check with your plan before making an appointment.

Remember that while the RSV vaccine is covered by Part D, your flu and COVID-19 vaccines will still be covered by Part B.

I hope this helps!

-Marci