By Cedar Dvorin and Marcelle Habibion (Photo: Cedar Dvorin)
If you watch television, you can’t miss the ads for Medicare’s open enrollment period (October 15 through December 7). For people with Medicare, open enrollment is your chance to make changes to your coverage.
Everyone with a Medicare Part D prescription drug plan should review their options during this period to make sure their current plan will continue to meet their needs. Each year the monthly amount you pay for your plan —the premium — and the cost of each prescription may increase or decrease. Plans can also change which drugs are covered — the formulary — and the amount of the annual deductible — the amount you must pay before your prescription drug plan begins to pay. Of the 25 plans available in Alexandria, 13 have the maximum $360 deductible in 2016 and 10 plans have no deductible. The premiums range from $18 to $124.50.
Reviewing your plan can result in significant savings. During a plan review, a senior learned that her current plan would not cover one of her prescriptions that cost $10,000. A change in plan brought the cost down to $3,200.
When choosing a plan, consider the plan’s convenience. Is your pharmacy in the plan’s network? Does it offer mail order? Review the plan’s annual and monthly cost to make sure it fits your budget. See if the plan includes all of your prescriptions in their formulary. Finally, check to see if the plan requires “step therapy” (starting with a similar but less expensive drug) or “prior authorization” (a form for your doctor to submit before the plan will cover the medication).
After you do your research, call the plan to confirm what you have researched. Keep a record of the conversation, including the date, time and the phone number you called from and the name of the representative with whom you spoke.
Open enrollment is also your chance to change between original fee-for-service Medicare and Medicare Advantage privately managed care plans. If you are interested in a Medicare Advantage plan, make sure the plan includes your doctors and hospitals in its network, covers all your drugs, and that the pharmacy is conveniently located.
Here are three ways to learn about your options:
Use Medicare’s Plan Finder on: www.medicare.gov. Select the green tab on the upper left side called “Find Health and Drug Plans.”
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Help is available in many languages.
Free, unbiased, confidential assistance in Alexandria is available at the Division of Aging and Adult Services. Call 703-746-5999 and ask for the VICAP (Virginia Insurance Counseling and Assistance Program) counselor.
Open Enrollment is an excellent time to check your Medicare Summary Notices and the Part D explanations of benefits, to help prevent Medicare fraud and abuse. If you see charges for something you did not get, contact Senior Medicare Patrol at 1-800-938-8885.
VICAP (Virginia Insurance Counseling and Assistance Program) is a free program offering individualized counseling to help with understanding Medicare, related insurance and Medicaid benefits.
The writers are the coordinator and a volunteer for the Virginia Insurance Counseling and Assistance Program, respectively.