Pick a prescription drug plan now to avoid a penalty later
If you’re a Medicare beneficiary but haven’t signed up for a prescription drug plan yet — or if you’re unhappy with your current one — you have until Dec. 7 to pick a plan without having to pay a late enrollment fee.
There are two types of plans you can choose from: A standalone prescription drug plan (PDP), which can be used under Part D of your Original Medicare Policy, or a Medicare Advantage Plan, which bundles your prescription drug plan into a single insurance policy along with all the other benefits of an Original Medicare plan.
These include in-patient hospital stays, skilled nursing facilities and hospice care, as well as physician visits, preventative care services and some home health visits.
In 2018, there will be an average of 23 PDP and 17 Medicare Advantage prescription drug plans available for beneficiaries to choose from, according to reports from the Henry J. Kaiser Family Foundation, a non-profit organization that analyzes health policy.
What that means for Medicare recipients is that it quite literally pays to shop around during open enrollment.
Right now the vast majority of beneficiaries (two-thirds) are enrolled in Original Medicare plans and rely on stand-alone PDPs to fill their scripts at pharmacies.
Next year, the monthly premiums for Part D prescription drug plans will increase on average by 9% — from $34 to $43.38. You can determine how much your own plan’s premium is going to increase by reviewing your Annual Notice of Change (ANOC) letter, which you should have received in the mail from your insurance provider by the end of September.
But your selection process shouldn’t stop at comparing premiums, cautions Juliette Cubanski, associate director of the program on Medicare Policy at the Kaiser Family Foundation.
“When it comes to looking at the stand-alone drug plans, people really need to pay their full attention to the drugs that are covered by different plans and the specific cost-sharing amounts the plans charge,” she says.
“Plans can really vary widely in terms of which drugs they cover and how much they charge, and those are obviously very important aspects for people in terms of getting access to their medication.”
It’s not just premiums, though. The list of preferred pharmacies or types of drugs covered, as well as the deductibles, cost sharing and tier placement (which can affect how much you, versus your insurer, pays for your medication) can be drastically different from one Part D drug plan to the next.
It requires beneficiaries to pay extra attention to all the different elements of their PDPs while comparison shopping, but it also means that if they do their homework, “beneficiaries may be able to save money by comparing other plans, whether that’s with their premiums or the cost of the medications,” says Fred Riccardi, director of client services for the Medicare Rights Center, a non-profit that helps people access affordable health care.
When reviewing drug plans, the first thing you should do is “make sure that your medication is on the formulary, so you’re not surprised when you go to the pharmacy and you’re charged full price for it,” Riccardi says.
If the process feels overwhelming, don’t throw up your hands, he advises. Instead, seek assistance from one of the Medicare open enrollment resources available.
You can go online to compare Part D prescription drug plans at medicare.gov/ find-a-plan. Over-the-phone assistance is available by calling the Medicare helpline at 1-800-MEDICARE.
Or, visit your local State Health Insurance Assistance Program (SHIP), which is known as HIICAP (the Health Insurance Information, Counseling and Assistance Program) in New York State, for in-person help. For more information on HIICAP, go to aging.ny.gov or call 800-701-0501