If you’re 65 or older, you know how valuable Medicare can be to cover the bulk of your medical expenses. But Medicare doesn’t automatically cover prescription drugs. You can get a Medicare Part D prescription drug plan to help with those costs, or you can get both health and drug coverage from a private insurer through a Medicare Advantage plan. You have an opportunity to shop for Part D coverage or Medicare Advantage plans during open enrollment every year, which runs from October 15 to December 7 to pick your plan for 2020.
Even if you’ve been happy with your plan, it’s always a good idea to check out your options during open enrollment — especially if you’ve been prescribed new medications since you chose a plan last year. And it’s particularly important to shop around this year because there have been some significant changes to the coverage, costs and resources. The following strategies can help you shop for a plan for 2020.
1. Compare your Part D options even if you’ve been happy with your plan. There may be new plans in your area that cost less — the average premiums are actually decreasing slightly, to $32.74 per month. But premiums are only part of the picture — a plan with low premiums could cost you more by the end of the year if it charges high co-payments for your drugs. And the plans can change their drug formularies and pricing tiers every year. Even if your drugs are still covered, your share of the cost may increase — for example, you may have been paying $40 per month for a preferred brand-name drug, but you may have to pay more than 30% of the cost each month if the plan switches the drug to the non-preferred list. You should have received an Annual Notice of Change from your plan in September explaining any changes to your current coverage.
2. Look for preferred pharmacies. Some of the Part D plans with the lowest premiums charge the lowest co-payments if you use a preferred pharmacy, but you’ll have to pay a lot more if you go to another pharmacy. You may, for example, have a $4 copay for some generics at a preferred pharmacy, but a $20 copay for the same medication at other pharmacies. Or you may have to pay 35% of the cost of some brand-name drugs at a preferred pharmacy, but 50% for the same drug at other pharmacies. Find out whether the pharmacies you use are in the preferred list, and be careful to go to the preferred pharmacy during the year — even if you and your spouse have different Part D plans. And find out if you can save even more by getting a 90-day supply of your medication from a preferred mail-order pharmacy.
3. Ask about less-expensive drug options. Before you compare plans, ask your doctor if there’s a generic version of your medication, which can save you a lot of money (some plans charge a $0 copay for preferred generic drugs). New generics come onto the market every year. If there’s no generic but you have a high co-pay for your medication, ask your doctor if there’s a “therapeutic equivalent” that meets a similar need but costs a lot less under your plan. Your insurer may have resources or Web tools that list possible alternatives to ask your doctor about. You can also find out more information about your drug and generic alternatives, as well as cost-saving strategies, at GoodRx.com.
4. Find out if there are new restrictions on coverage for your medications. Many prescription drug plans now require you to jump through hoops before they will cover some more-expensive medications. The plan may only cover the drug with “prior authorization,” requiring your doctor to fill out forms explaining why you need to use that particular medication. Or it may have a “step therapy” requirement — only covering the medication if you’ve tried less-expensive drugs first.
5. Find out about changes to your Medicare Advantage plan. If you get medical and drug coverage from a private insurer through a Medicare Advantage plan, it’s always important to review your coverage every year to make sure that the doctors and hospitals you want to use are still covered in the plan’s network, and to find out how the drugs you take are covered — provider networks, formularies and drug pricing tiers can change. You should have received an Annual Notice of Change in September from your Medicare Advantage plan explaining any changes to the plan for 2020.
6. Look at new Medicare Advantage options. Insurers can enter or leave the market each year, and they can make some big changes to Medicare Advantage plans for 2020, so it’s a good idea to look at all of the options available in your area. Compare premiums as well as out-of-pocket costs for your medications and the type of care you usually use, and make sure the doctors and hospitals you want to use are covered, too. Also compare the star ratings for the plans you’re considering, which is Medicare’s assessment of the plans based on coverage, care and customer service. You can find the cost, coverage and ratings of all of the plans in your area by using the Medicare Plan Finder. Also, HealthMetrix Research does a good analysis of Medicare Advantage plans in 63 cities at MedicareNewsWatch.com, which lists the best Medicare Advantage plans by area based on typical costs for people in good, fair and poor health.
7. Find out about Medicare Advantage’s new supplemental benefits. This year is particularly important to shop for Medicare Advantage plans because new rules expanded the types of coverage that insurers can provide. Medicare Advantage plans have always been able to provide some additional coverage beyond Medicare’s benefits, such as dental and vision care, hearing aids and gym memberships. But this year Medicare Advantage plans can add more supplemental benefits, such as in-home services, adult day care, nutrition, home modifications, and support for family caregivers. Find out if the plan is offering any of these additional benefits, but it’s still important to focus primarily on the cost and coverage for the doctors, hospitals and prescription drugs you typically use.
8. Learn how to navigate the new Plan Finder. Medicare.gov’s Plan Finder tool has always been the best way to compare all of the plans available in your area, whether you have Part D or a Medicare Advantage plan. You can type in your drugs and dosages and find out how much you’d pay in total costs over the year for your medications — adding up premiums plus co-pays for your specific drugs. If you have a Medicare Advantage plan, the tool shows coverage details and can also estimate the out-of-pocket costs for someone with your general health condition and for your medications. The tool was updated in August and now gives you more personalized information using your Medicare claims data if you log into your www.MyMedicare.gov account.
9. Take advantage of other resources to help you choose a plan. The State Health Insurance Assistance Programs (SHIP) provide personalized assistance to help you shop for a plan. SHIP counselors often hold group seminars in senior centers and retirement communities during open enrollment, too. Go to www.shiptacenter.org to find your local SHIP. The Medicare Rights Center also has a lot of information to help you choose a plan at its Medicare Interactive site.
Saturday Insurance Services, LLC (“Saturday” or “Saturday Insurance”) is a licensed, digital insurance advisor. All tools, quotes, and information provided by Saturday are for educational purposes only and based on the limited information, if any, provided by you. We urge you to consult with your financial and tax advisors before making any purchase decisions. All quotes and estimates are non-binding and are not to be construed as a guarantee you will be able to purchase insurance. Availability of insurance and final pricing is determined solely by our insurer partners and subject to their review and acceptance of a completed application. All product guarantees are subject to the claims-paying ability of your insurer.