No one claims that understanding Medicare is easy. Researching and enrolling in the right plan for you can be a daunting challenge. You might think that once you’re in, you’re done. But that’s not the case!
If you want to ensure that your coverage still fits your needs from year to year, then you should read this guide on what you should review about your Medicare plan and your Medicare drug coverage every year.
That’s because the Centers for Medicare & Medicaid Services (CMS) changes the rules and regulations for coverage every year.
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If you have a private Medicare Advantage (Medicare Part C) plan and/or Medicare Part D prescription drug coverage, your plan carrier may also change aspects of your plan for the upcoming year. This can be true for you basic medical coverage and, often most important, for your prescription drug coverage.
For these reasons, it’s important to review your plan every year to ensure it meets your coverage needs.
Some of the most important changes to your Medicare plan coverage from one year to the next can affect your prescription drug coverage.
Every year, Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage review the drugs they choose to cover (which are listed in the plan formulary) and how they are priced (which tier they’re on in your plan formulary).
For example, a drug you take may be moved from tier 1 of your plan – typically the formulary tier with the lowest drug costs for you – to tier 2 or 3, which may typically require a higher copayment requirement.
In addition, rules for prior authorization from your doctor may change. Or your plan may enter into an agreement with a particular pharmacy for better pricing. If that pharmacy isn’t an option for you, you may end up paying more than you have to.
Also, new Medicare plans may enter the marketplace in your area that feature different formularies and different tiers than your current plan. These changes could potentially significantly impact what drugs are covered and how much they cost you if you were to switch to the new plan.
If you don’t like some of the changes to your Medicare plan this year, you can consider comparing coverage options and shopping for plans. When you do, you may find plans in your area that:
Comparing plans online or by calling to speak with a licensed insurance agent also allows you to get:
When reviewing your Medicare plan coverage, have the full list of all your prescription drugs and dosages handy. Check to see that your medications are on the formulary of any new plans you’re considering, and compare the costs at more than one pharmacy.
Remember to compare not only the monthly premium for different plans, but also monthly copayments and whether there are any other restrictions, like step therapy or quantity limits.
CMS recommends you mark your calendar with these important Medicare enrollment dates and tasks:
In certain cases, you may be able to make other changes to your coverage if you qualify for a Special Enrollment Period.
Compare plans for free online, or call today to speak with a licensed insurance agent who can help you compare Medicare plans available where you live.
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David Levine is an award-winning writer and editor whose work has been featured in the New York Times, New York Daily News, Sports Illustrated, American Heritage, U.S. News & World Report and others.
David has covered health, health insurance and health policy topics – among many others – since 2017. He earned a Bachelor's Degree in English from the University of Rochester and currently lives in Albany, New York.
LinkedIn: David Levine