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When Should You Keep the Same Medicare Prescription Drug Plan?


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Your Medicare Prescription Drug Plan might cover your prescription drugs with out-of-pocket costs that you can live with. But it’s possible that you can find a Medicare Prescription Drug Plan that still may cover your medications – but at a lower cost to you.

Medicare Prescription Drug Plans: a quick rundown

You can usually get Medicare prescription drug coverage in either of two ways.

  • From a stand-alone Medicare Part D Prescription Drug Plan to complement your Original Medicare (Part A and /or Part B coverage)
  • Through a Medicare Advantage Prescription Drug plan. A Medicare Advantage plan gives you an alternative way to get your Medicare Part A and Part B benefits.

Both types of plans are available from private, Medicare-approved health insurance companies.

Medicare Prescription Drug Plans: can I save money if I change plans?

  • About 90% of people who shopped for Medicare Prescription Drug Plans using eHealth’s plan comparison tools could have found a lower-priced plan than what they had. That’s according to a 2017 eHealth Medicare Choice and Impact report.
  • The eHealth study found that the people in the study could save an average of $541 in 2017 by using eHealth’s plan comparison tools. The costs that this figure takes into account include monthly premiums, copayments, coinsurance, and deductibles.
  • According to the Centers for Medicare & Medicaid Services, at least 76% of Medicare beneficiaries in every state had access to Medicare Prescription Drug Plans with lower premiums than what they paid the year before. In many states, the percentage was higher. The report was released in 2016.

Medicare Prescription Drug Plans: how do you know if they cover your prescription drugs?

Medicare Prescription Drug Plans aren’t “one size fits all.” Plans can have different costs, such as premiums, deductibles, and coinsurance.

But every Medicare Prescription Drug Plan has its own formulary. The formulary lists the prescription drugs it covers, as well as which cost tier each drug is in. So, if you’re looking for a Medicare Prescription Drug Plan, you’ll want to make sure it covers your medications.

Medicare Prescription Drug Plans: can they change their formularies?

Yes, Medicare Prescription Drug Plans can change their formularies. This is why you may not want to just sign up for a plan and forget about it, assuming the coverage will be the same year after year.

Every fall, every Medicare Prescription Drug Plan sends an Annual Notice of Change (ANOC) to every plan member. It may be wise to check your plan’s ANOC every year to see if your medications are still in the formulary, and whether there have been changes to your out-of-pocket costs.

A Medicare Prescription Drug Plan can change its formulary other times, too, for certain reasons – not just in the fall. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

Medicare Prescription Drug Plans: should I change plans?

Only you can decide whether you should change Medicare Prescription Drug Plans. Remember, it’s not just the plan premium you should consider. Compare deductibles, coinsurance, and copayments too.

Here’s one easy way to compare Medicare Prescription Drug Plans. Just enter your ZIP code in the box on this page and click the button beside it. You’ll see a list of stand-alone Medicare Part D Prescription Drug Plans available in your area. Click Add Rx Drugs to list your medications. This makes comparing plans even easier, because you can see if a selected plan covers your medications, and for what cost.

Note that from eHealth’s plan comparison tool, you can click the Medicare Advantage Plans box to display Medicare Advantage plans. The resulting list tells you whether the plan covers prescription drugs. Again, you can click Add Rx Drugs to list your medications.

When can I change Medicare Prescription Drug Plans?

Whether you’re enrolled in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, there are specific times when you can switch plans.

  • If you’re still in your Medicare Initial Enrollment Period, and you’ve already enrolled in a Medicare Prescription Drug Plan, you can change to a different plan only if you do so before the effective date of the first plan you signed up for.
  • You can generally change Medicare Prescription Drug Plans during the Annual Election Period (AEP), also known as the Medicare Open Enrollment Period. This period runs from October 15-December 7 every year. During this time, you can typically:
  • Change from one stand-alone Medicare Part D Prescription Drug Plan to another
  • Change from one Medicare Advantage Prescription Drug plan to another
  • Change from one Medicare Advantage plan to another, regardless whether either plan includes prescription drug coverage
  • Sign up for a Medicare Advantage Prescription Drug plan
  • Sign up for a stand-alone Medicare Part D Prescription Drug Plan

You might be able to make other coverage changes during the AEP.

  • You may be able to make a one-time change from one Medicare Advantage plan to another during the new Medicare Advantage Open Enrollment Period starting in 2019. You might be able to make certain other coverage changes.
  • In certain situations, you might be able to change Medicare Prescription Drug Plans if you qualify for a Special Enrollment Period. This generally involves a loss of coverage, like if you lose employment-based coverage, or you move out of your plan’s service area.

Do you have questions about Medicare Prescription Drug Plans? We’re here to help. Just call eHealth to speak with a licensed insurance agent.

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