Seniors who want to make changes to their Medicare coverage have until Dec. 7 to do so. At that time, the 2016 open enrollment period will end, and for most people, their coverage will be locked in for the following year.
Retirees typically have a variety of options for Medicare Part D plan prescription drug coverage. A Kaiser Family Foundation analysis found the average Medicare beneficiary is expected to have 22 plans from which to choose, fewer than in any year since 2006. However, the number of plans can make the open enrollment period a confusing time for some. “Medicare can be such a complex web of choices, especially when it comes to dual-eligible people,” says Michael Carson, chief operating officer of ConcertoHealth, which specializes in helping those who receive both Medicaid and Medicare coverage.
[See: 10 Things You Need to Know About Medicare.]
To simplify the process, here are five easy steps to follow.
Step 1: Make sure you actually need a Part D plan. Medicare Part D is a standalone policy available only to those ages 65 and older with original Medicare or without other prescription drug coverage. Those who have a Medicare Advantage or Part C plan that includes prescription drug coverage don’t need a Part D plan. Some Medicare Cost Plans also provide prescription drug coverage, so members don’t need to purchase a separate Part D plan. You only need to buy a Part D plan if you have original Medicare or a Medicare Advantage or Cost plan that doesn’t pay for prescription drug coverage.
Step 2: Check in with your doctor. Have a conversation with your doctor about your potential medication needs for the coming year. “I strongly suggest Medicare beneficiaries talk to their doctors and medical team,” Carson says. “They can be a great help in picking a Part D plan.” In particular, a doctor can review your prescription drug needs so you can double check that the medications you currently need or may need in the near future are covered. Doctors may also have insight, based on feedback they’ve received from other patients, into which insurers are most likely to cover those prescriptions.
[Read: 5 Reasons to Switch Medicare Part D Plans.]
Step 3: Review the plan’s formulary. This is perhaps the most important step in selecting the right Medicare Part D plan. “We see folks looking to the premium and focusing on the premium exclusively,” says Kent Monical, senior vice president of UnitedHealthcare’s Part D plans. “That’s not to diminish the importance of premiums,” but an inexpensive plan that doesn’t cover your prescriptions is a waste of money.
Each insurer maintains a drug list, known as a formulary, which includes all the medicines covered by a plan. These medications may be split into tiers with different co-pays. In some cases, a person may be required to try a medicine on a lower tier before the plan will pay for a prescription drug listed on a higher tier. When reviewing the formulary, don’t look only for the drugs you already take, but check for ones your doctor says you might try within the next year.
Step 4: Calculate your total out-of-pocket cost. Premiums for Part D plans will be going up next year. The average price in 2017 will be $42.17 a month, up 9 percent from 2016, according to KFF calculations. The average premium price varies by state with the lowest average price in New Mexico and the priciest average premium in New Jersey
However, the premium is only one part of the cost. Medicare beneficiaries should also total up their expected co-pays, coinsurance and deductibles for each plan to determine which policy will keep their total out-of-pocket costs to a minimum.
[See: 10 Medical Services Medicare Doesn’t Cover.]
Step 5: Double check the pharmacy network. Seniors shouldn’t settle on a plan without first reviewing its pharmacy network. “If they go to Joe’s local pharmacy, is that covered?” Carson says. “They may have to go to Walgreens instead.” Some plans put restrictions on 90-day supplies of medicine or require the use of mail order providers for certain drugs. Medicare beneficiaries should be sure the Part D plan will make it convenient, as well as affordable, to fill their prescriptions.
Even if you like your current Part D plan, don’t skip these five steps. The coverage and cost of policies can change each year. “It does require an investment of time [to compare options], but it is time well-spent,” Monical says.
More from U.S. News
6 Social Security Changes Coming in 2017
Medicare Enrollment Deadlines You Shouldn’t Miss
How to Apply for Medicare Without Claiming Social Security
5 Steps to Picking the Right Medicare Part D Plan originally appeared on usnews.com
