To save money, shop around for Medicare Part D drug plans
Part D, the prescription drug plan of Medicare, has more than 48 million beneficiaries enrolled nationwide, making it Medicare’s most popular plan.
It helps Medicare beneficiaries pay for both brand-name and generic drugs.
Given this, it’s important to compare plans during the Medicare open-enrollment period, which ends Dec. 7 , say Medicare experts.
“They may change the monthly premium, what drugs they cover and how much they charge to fill a prescription,” says Tricia Neuman, senior vice president of Henry J. Kaiser Family Foundation (KFF) and executive director of KFF’s program on Medicare policy. “It’s not a lot of fun to compare plans, particularly when there may be dozens in an area, but taking the time to compare plans can make a real difference.”
In Florida, 4,760,726 individuals are enrolled in Medicare.
‘‘ IT’S NOT A LOT OF FUN TO COMPARE PLANS … BUT TAKING THE TIME TO COMPARE PLANS CAN MAKE A REAL DIFFERENCE Tricia Neuman, senior vice president of Henry J. Kaiser Family Foundation
CHANGES YOU CAN MAKE DURING MEDICARE OPEN ENROLLMENT PERIOD
During the Medicare open enrollment period, according to Medicareresources.org, enrollees can:
Switch from Original Medicare to Medicare Advantage (as long as you’re enrolled in both Medicare Part A and Part B, and you live in the Medicare Advantage plan’s service area).
Switch from Medicare Advantage to Original Medicare (plus a Medicare Part D plan, and possibly a Medigap plan).
Switch from one Medicare Advantage plan to another.
Switch from one Medicare Part D prescription drug plan to another.
Enroll in a Medicare Part D plan if you didn’t enroll when you were first eligible for Medicare.
AAAAAPART D AVERAGE PREMIUM FOR 2022 AND INSULIN COSTS
The Centers for Medicare & Medicaid Services (CMS) announced recently that the average basic monthly premium for standard Medicare Part D coverage is projected to be approximately $33 in 2022 — an increase of 4.9% from $31.47 in 2021.
The average premium for Medicare Advantage plans will be lower in 2022, at $19 per month, compared to $21.22 in 2021. Medicare Advantage programs often have lower costs as many operate as an HMO, limiting members to their networks of physicians.
CMS said it will continue to test the Part D Senior Savings Model in more than 2,100 plans in 2022, which will increase access and affordability to select insulin drugs for seniors.
CMS recently released the premium and costsharing information for 2022 Medicare Advantage and Part D plans.
“2022 will be the second year of the Part D Senior Savings Model, in which enrollees in model-participating plans can access insulins marketed by model-participating pharmaceutical manufacturers at a maximum $35 copay for a onemonth supply in the deductible, initial coverage, and coverage gap phases of the Part D benefit,” says Kristen Clemens, a spokesperson for CMS.
Over 500 new Medicare Advantage and Part D prescription drug plans, and two new pharmaceutical manufacturers of insulin, are joining the model this year to provide more opportunities for eligible seniors to reduce their out-of-pocket spending on insulin, per a recent press release from CMS.
ENROLLING IN MEDICARE PART D
The first opportunity for Medicare Part D enrollment is when you’re initially eligible for Medicare — during the sevenmonth period beginning three months before the month you turn 65, or during the seven-month period beginning three months before your 25th month of disability, according to Medicareresources.org. (Eligibility rules are different if a person is enrolling in Medicare due to a diagnosis of ALS or end-stage renal disease.)
In both of these cases — whether you’re turning 65 or are eligible for Medicare because of a disability — you have the option of selecting a Medicare Advantage plan that includes Part D prescription drug coverage, and using that in place of Medicare A, B, and D.
If you enroll in Medicare during the January– March general enrollment period, you can enroll in Part D between April 1 and June 30.
If you’re enrolled in a
Medicare Advantage plan and use the Medicare Advantage open enrollment period (Jan. 1 to March 31) to switch to Original Medicare, you can sign up for a Part D plan to supplement your Original Medicare coverage.
There will be 583 Medicare Advantage plans available in 2022, compared with 526 plans in 2021.
CHANGES TO MEDICARE PART D IN 2022
Here are the major changes, according to CMS:
Twenty two standalone Medicare prescription drug plans are available in 2022. (Everyone with Medicare has access to a Medicare prescription drug plan.)
Eight stand-alone Medicare prescription drug plans and 244 Medicare Advantage plans with prescription drug coverage will offer lower out-of-pocket insulin costs through the Part D Senior Savings Model.
100% of people with a stand-alone Medicare prescription drug plan
AAA
have access to a plan with a lower premium than what they paid in 2021.
27% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).
AMEDICARE FORMULARY: WHAT TO KNOW
During the year, a Part D plan may make changes to its formulary — dropping some prescription drugs from coverage or adding some that weren’t covered before — according to Medicare regulations. If the change involves a drug you’re currently taking, the plan must either send you a written notice at least 60 days before the change takes effect, or at the time you request a refill, notify you of the change in writing and provide a 60-day supply of the drug.
If the plan has stopped covering your drug because of a safety issue, due to a recall, the plan is not required to inform you.
No Part D plan covers all drugs but all plans are required to cover at least two drugs in each class of medications — drugs that are used to treat the same medical condition.
Each plan must cover all or nearly all the drugs used to alleviate six serious conditions: cancer, epilepsy, depression, psychoses, HIV/AIDS and organ transplants, according to AARP.
If your Part D plan does not cover or stops covering a drug that your doctor has prescribed as necessary for your health, you and your doctor can request the plan make an exception to its rules and cover the drug in your case.
HOW TO GET HELP FROM SHINE ON MEDICARE QUESTIONS
The Florida Department of Elder Affairs’ SHINE program can help with insurance comparisons.
Representatives can help you navigate the plan-finder tool at www.medicare.gov to find the least expensive Part D plan or Medicare Advantage Plan that includes your drugs.
SHINE’s services are free and confidential. To be connected with the SHINE program in your area, call 1-800-96-ELDER (1-800-963-5337) and ask for SHINE or go to www.floridashine.org and click on “Contact Us.”
The phone number for SHINE in Miami-Dade or the Keys is (305) 6716356. In Broward County, it’s (954) 745-9567 and (561) 684-5885 in Palm Beach County.
Enrollees can also call 1-800-MEDICARE (1800-633-4227) or can contact their State Health Insurance Programs https://www.shiphelp.org/ for one-on-one assistance.