Every year during the Medicare Open Enrollment Period from October 15th to December 7th, Medicare beneficiaries can change their Medicare coverage to better fit their health care and budget needs.
Enrollees can switch from Medicare Advantage to Original Medicare or vice versa, choose a different Medicare Advantage plan, or they can switch, add, or drop Part D prescription drug coverage.
Unless you qualify for an Extra Help program or qualify for a Special Enrollment Period, OEP may be the only time you can change your Part D prescription drug coverage. During this period you can make as many changes as you’d like as long as you do so before December 7th. You don’t need to cancel your old drug plan. It cancels automatically when your new plan takes effect on January 1st of the new year.
Six things to consider about Part D prescription drug coverage during OEP
1. Are your preferred medications listed on the new plan’s formulary?
Having access to the prescription drugs you are taking, or are used to taking, should be your number one priority in finding a new Part D plan. When you’re searching for available Prescription Drug Plans or Medicare Advantage plans with prescription drug coverage in your area, compare those plans that have your specific drugs listed on their formularies.
You can find a plan’s formulary – or list of covered drugs – online or in printed form. Once you know which Part D plans cover your prescriptions, you can then compare costs and coverage regulations.
2. Does it protect you from high drug costs within the coverage gap?
As an extra cushion from high prescription costs, check out Part D plans that provide better coverage (or lower coinsurance rates) when you enter the coverage gap. The coverage gap is also known as the donut hole. This is a temporary limit on what your plan pays for your prescription drugs after you have reached the coverage limit. In 2021 the coverage limit is $4,130.00. This will go up to $4,430.00 in 2022.
Most Part D prescription drug plans have a 25 percent copay for generic and brand-name drugs while plan enrollees are in the coverage gap. However, there are prescription drug plans that have better coverage available.
If you have high prescription drug costs, finding coverage that offers this protection can be valuable. Make sure the new plan includes your specific drugs in its coverage within the coverage gap (donut hole) before you enroll.
3. Does it balance your expenses throughout the year?
If you live on a fixed income, you might be better off having your drug expenses spread out more evenly during the year. A Part D plan that has a zero, or low deductible; or provides extra coverage during the coverage gap, may be a good option.
4. Are your prescriptions mainly generic?
There are many Medicare Part D plans available with a zero, or a very low, copayment for tier-one generic prescriptions. If the prescription drugs you’re taking are generic, you can save a lot of money by enrolling in a plan like this.
5. Does it protect you in the future even if you don’t need coverage now?
You might not need comprehensive prescription drug coverage when you first enroll in Medicare. However, you can never be certain about what you might need in the future.
For your own peace of mind, and to avoid future penalties, you can look for a Medicare Part D plan that has a low monthly premium. These types of plans may not cover as many prescription drugs as other plans, but enrolling in one ensures that you’ll have coverage for drugs that are commonly used by Medicare beneficiaries if you need them.
6. Do you want coverage in one plan?
If you don’t mind having restrictions on what health care providers you can visit, or what medical facilities and suppliers you can use, enrolling in a Medicare Advantage plan that includes prescription drug coverage (MAPD plan) may be a good solution.
Most Medicare Part C plans include additional prescription drug coverage (MA-PDs) and extra benefits bundled together with the basic benefits of Medicare Parts A and B. Compare plans online to find the one that is right for you.