Now that our TV’s are flooded with advertisements about the annual enrollment period, there are some important reminders to think about as you look at your Medicare prescription drug plan. While premium tends be the first thing on everyone’s mind, shopping includes a lot more areas to investigate, as it is important to evaluate the true plan cost when evaluating your prescription coverage.
Does my plan have a deductible?
While the Medicare base guidelines allow plans to have a deductible, sometimes the deductible is waived for some generic medications when you go to certain “preferred” pharmacies. This can save you from a higher premium throughout the year if you only take a few generic medications.
Does the plan limit my options of pharmacies that I can go to?
Some carriers give their members incentives to go to their preferred pharmacy. This will vary from carrier to carrier, so if you prefer to get your prescriptions at the pharmacy around the corner, make sure you know if they are considered a preferred pharmacy. Typically preferred pharmacies will have lower copayments than non-preferred locations.
Is there coverage during the “Doughnut hole/Coverage Gap?”
With the implementation of the Affordable Care Act, the doughnut hole/coverage gap will reduce down each year until 2020 when it will close up. Some plans may offer generic medications at their defined copayments during the coverage gap.
During AEP, can I change from a Medicare Advantage plan to a Medicare Supplement?
If your Medicare Advantage plan is leaving the service area, you are eligible for a guarantee issue period and can enroll in a Medicare supplement without medical underwriting. Also if your Medicare Advantage plan has increased its out of pocket costs, you may be eligible to move to a Medicare supplement without going through medical underwriting. There are several factors to consider, and I would be happy to discuss your specific situation with you.
Plans are changed each year, even if the plan name does not change it is always important to review the Annual Notice of Change that you receive from your plan. Formularies and other benefits may have changed and can only make changes during the AEP window of October 15 to December 7, unless you qualify for a Special Election Period.
If you have questions on Medicare prescription drug plans, and need help during this AEP, please don’t wait till December 7th! You can reach me at 559.634.7116 so we can discuss your personal situation to make sure you have the right Medicare plans to meet your needs.