Hale Law Blog

What You Can Do During Medicare Open Enrollment

Medicare open enrollment runs through December 7, and it is a good time for beneficiaries to make sure they are satisfied with their Medicare Part D prescription drug coverage. During open enrollment, people on Medicare can shop around for Part D plans and the optional Medicare Advantage plans.

If a beneficiary’s health or prescriptions for medication have changed in the past year, then it might be a good idea to compare plans. It also may be that the plan itself is what has changed: many plans have increased premiums or copayments or changed the pricing tiers for prescription medication. If an insurer moves drugs from one pricing tier to another, that can have a significant effect on one’s out-of-pocket costs.

Some insurers have up to five different tiers of prescription drug pricing, and if a medication moves from a preferred to a non-preferred or specialty drug, the patient may have to pay up to 25 percent of the cost out-of-pocket. Price differences between generic and name-brand drugs are common, but some plans also have different tiers for preferred generic and non-preferred generic drugs.

One recent change in Part D is the growth of preferred pharmacy plans. Some insurers offer low premiums and low copayments if one uses a particular chain of pharmacies. The savings can be substantial when one uses the preferred pharmacy.

One can compare plans on Medicare.gov’s Plan Finder. Entering one’s zip code and medications and clicking on “prescription drug plans” brings up the plans available to the individual. The star ratings are useful in choosing a plan, because they incorporate actual members’ reported satisfaction with the plan.

Open enrollment is also an opportunity to choose a Medicare Advantage plan, if desired. To cover hospital care (Part A) and outpatient care (Part B), Medicare offers a choice between single-payer traditional Medicare or a network plan (Part C or Medicare Advantage), in which the federal government pays for a private insurer that the patient can choose. The majority of Medicare beneficiaries choose traditional Medicare, but if one chooses Medicare Advantage, now is when one can shop around among different plans.

One potential source of confusion that Medicare beneficiaries will want to avoid is that this is also the open enrollment period for the new health insurance exchanges under the Affordable Care Act. However, the two are completely separate. The health insurance exchanges are for people who do not have health insurance, and Medicare beneficiaries do have health insurance, through Medicare. The online location to compare Medicare plans is Medicare.gov, not Healthcare.gov.

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