10/12/2022
Medicare Interactive
Medicare Minute Script — October 2022
Changing Part D Plans
Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone prescription drug plan for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan. Sometimes a Part D plan’s premium increases or the plan does not cover your new medication. Today we’ll discuss how you can choose and enroll in a new Part D plan.
Point 1: Choose a Part D plan that meets your health care needs.
Before you start looking at plans, make sure you know the prescriptions you take, the dosages of each, and the pharmacies you usually use. To compare different plans available to you, you can use Medicare’s Plan Finder tool at www.medicare.gov/plan-compare. For assistance comparing plans, you can call 1-800-MEDICARE or your local State Health Insurance Assistance Program, also called SHIP. When choosing a Part D plan, make sure to ask the following questions:
1. Does this plan cover my drugs? You should also find out if there are any restrictions on your covered drugs, such as prior authorization, step therapy, or quantity limits.
2. What are the costs associated with this plan? Plan Finder provides an estimated out-of-pocket cost for the year for each plan, based on your medications and dosages.
3. Are my pharmacies preferred and in-network? You will pay less at preferred in-network pharmacies.
4. What is the plan’s star rating? Medicare uses a star rating system to measure how well plans perform in different categories, like quality of care and customer service. Plan Finder includes plans’ star ratings.
While comparing plans, it may be helpful to know that starting in 2023 all Part D plans will cover vaccines with zero cost-sharing and will cap monthly insulin cost-sharing at $35, due to the Inflation Reduction Act.
Point 2: Understand when you can change your Part D plan.
You can make changes to your coverage during Medicare’s Open Enrollment Period, which spans October 15 through December 7 each year. Part D plans may change their cost and formularies from year to year, so it is important to review your plan notices to learn if prices will change and if your drugs will still be covered next year.
If you receive your drug coverage as part of your Medicare Advantage Plan, you can also make changes during the Medicare Advantage Open Enrollment Period, which spans January 1 through March 31 each year. This period can be helpful for anyone who is not satisfied with the change they made during the fall.
You can also make a change to your Part D plan if you qualify for a Special Enrollment Period, or SEP. For example, those enrolled in Extra Help, the federal program that assists with drug costs, have SEPs each year to change their drug coverage. You also have an SEP if you move outside your plan’s coverage area. You should call Medicare or your SHIP to see if you qualify for an SEP.
Point 3: Know how to disenroll from your Part D plan and enroll in a new plan.
You can call 1-800-MEDICARE to enroll in your new plan without disenrolling from your old plan. You should be automatically disenrolled from your previous plan when your new plan’s coverage begins. You can also call a plan directly to enroll through a plan representative, but note that it is helpful for Medicare to have the official enrollment record in case there are any problems.
Point 4: Check your Medicare statements for potential fraud, errors, or abuse.
Your Medicare Advantage Plan or Part D prescription drug plan typically sends you a statement after you receive medical services or items. This is called your Explanation of Benefits, or EOB. You only receive an EOB if you have Medicare Advantage or Part D. It is important to remember that an EOB is not a bill. It is an explanation of services and items you have received and how much you may owe for them. It tells you how much your provider billed, the approved amount your plan will pay, and how much you may owe your provider. Compare your statements to your record of medical visits, tests, receipts for services, and equipment received. You can use the My Health Care Tracker from the Senior Medicare Patrol, called “SMP.”
It is important to read your EOB as soon as you receive it to ensure you actually received all the medications or services listed. If you think there has been a billing error, first call your health care provider or plan to try to get it corrected. If the potential errors are not corrected, if you have additional questions, or if you need a My Health Care Tracker, contact your SMP. The SMP program empowers and assists Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse.
This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.
SHIP National Technical Assistance Center: 877-839-2675 | www.shiptacenter.org | [email protected]
SMP National Resource Center: 877-808-2468 | www.smpresource.org | [email protected]
© 2022 Medicare Rights Center | www.medicareinteractive.org | The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center.
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