There are many reasons why it’s a prudent move to switch your Medicare Part D plan.
A good Part D plan covers what you need to stay healthy without breaking the bank. Staying current with any changes and reviewing your plan’s benefits before the annual open enrollment period can help you identify potential savings, improve your prescription drug coverage and, ultimately, enhance your overall well-being.
It is to your advantage to sit down once a year before the open enrollment period
, which runs from October 15 to December 7, and review your current plan. In September, your plan should send you a notification outlining any plan changes for the upcoming year.
“I always encourage individuals to put together a full list of their medications, including the name of the prescription, dosage and frequency,” advises Jen Teague, the director of health coverage and benefits at the National Council on Aging in Arlington, Virginia. “Beneficiaries can then more easily put their prescriptions into the Medicare plan finder tool to find the best plan for them based on the prescriptions they take.”
[Read: 5 Steps for Picking a Medicare Plan.]
What Is Medicare Part D?
Medicare Part D plans provide prescription drug coverage to Medicare beneficiaries. They are standalone plans, administered independently by a private health insurer, that can only be used with original Medicare, also known as Part A (hospital insurance) and Part B (medical insurance), to create more comprehensive overall prescription coverage.
Each Part D plan has its own formulary (list of covered drugs) and cost structure.
[READ: Medicare Mistakes to Avoid.]
Reasons to Switch Medicare Part D Plans
There are many factors to take into consideration when switching your Part D plan, including:
1. Changes in health status
Your medication needs may not always align with changes to your plan’s formulary coverage.
If you are newly diagnosed with a chronic condition, you may benefit from checking Part D plans to find one that offers better coverage for your specific medications.
2. Cost savings
Is your plan still the most cost-effective option you have? Other plans may offer lower premiums and deductibles or more favorable copayment or coinsurance structures.
3. Customer service
Sometimes you have questions that can only be answered by a person. If it is difficult to reach someone or if when you do, they frequently cannot answer or give incorrect answers, a change may be in order.
4. Formulary adjustments
Check the plan’s drug formulary in case they no longer will cover your medication or it has changed tiers, possibly making it costlier.
Also, if you have been prescribed new medications it can’t hurt to see if another plan covers them at a lower cost.
5. Life changes
If you move where your current plan is not available or where other plans offer better local coverage and pharmacy networks you can check Medicare.gov to see if you qualify for a special circumstance switch.
6. Pharmacy network changes
Some plans have preferred or in-network pharmacy networks where getting your medication will come with a lower price tag.
However, if your regular pharmacy isn’t in this network or none of your options are convenient, you may want to look at other plan options.
7. Plan performance
Switching to a plan with higher star ratings from Medicare can indicate a higher level of customer service, more formulary options and fewer issues with claims and coverage.
Go to the Medicare plan finder tool to compare plans and find their star ratings. Ratings are based on various factors, such as customer service, member complaints and drug pricing.
8. Regulatory changes
Your current plan may be discontinued or undergo significant changes that no longer make it your best option.
[When (and How) to Sign Up for Medicare if You’re Still Working]
Part D Enrollment
There are four specific enrollment periods for Medicare when changes can be made to a Part D plan:
“Many beneficiaries do not realize that the open enrollment period may be the only chance they have to change their Part D plan for the following year,” Teague says. “Plan premiums, deductibles, copayments and in-network pharmacies may change from year-to-year, and this is the opportunity to make a change that is in their best interest for the following year.”
Upcoming Changes in 2025
When evaluating a Part D switch, it’s important to factor in the changes coming to the entire Part D program in 2025.
The Inflation Reduction Act aims to reduce prescription drug costs for Medicare beneficiaries by eliminating the coverage gap, capping out-of-pocket expenses and implementing other cost-saving measures in 2025.
Some notable upcoming changes that will affect all plans include:
— Elimination of the coverage gap. In 2024, once you and your plan have spent $5,030, you will pay a higher percentage of the cost of your prescription drugs until your out-of-pocket costs reach $8,000. The law eliminates this “donut hole” in coverage, making medications more affordable to beneficiaries throughout the year.
— Limit on annual premium increases. The law limits annual increases in Part D premiums to no more than 6% a year from 2024 through 2029.
— Limit on out-of-pocket costs. In 2024, this law limited the max out-of-pocket beneficiary needed to spend on Part D medications to $3,333. In 2025, it will fall further to $2,000. You will also have the option to pay your out-of-pocket costs spread out in monthly amounts instead of as they come.
How to Evaluate and Switch Plans
Evaluating plans can be time-consuming and arduous, but, ultimately, a smart move. With careful consideration, you can find a plan that best fits your needs and budget.
Steps to take are:
— Understand your needs. Before doing any research into plans, do your best to understand what you are looking for. Talk to your doctor about any changes or new medications and make a list that you can then compare with plan formularies. Also, decide how much you can reasonably afford for premiums, copays and deductibles.
— Compare plans. Use the Medicare plan finder tool to compare plans based on your zip code, medications and budget. Check the formularies and tiers for each drug you take to make sure it not only is there, but it is affordable. Review the star ratings of each plan keeping in mind they are ranked from one to five stars, with five generally indicating better plan performance. Make sure your preferred pharmacy is in-network.
— Make the switch. Once you are comfortable with your decision, it’s time to commit. This can be done by phone, mail or online during one of the enrollment periods. You can sign up directly in your online Medicare account, by completing and mailing an enrollment form to the new plan or on the phone by calling 1-800-MEDICARE (1-800-633-4227).
It is important to note that you do not need to cancel your current plan; it will automatically end when your new coverage begins.
Bottom Line
It’s a smart decision to assess whether your current Medicare Part D plan is still your best option or if switching would be in your best interest. There are many reasons to switch, including formulary adjustments, cost savings and changes in your medication needs.
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8 Reasons to Switch Medicare Part D Plans originally appeared on usnews.com
