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 plan’s premium increases or the plan does not cover your new medications. In this blog post we’ll discuss how you can choose and enroll in a new plan for your Medicare Part D prescription drug benefit.
First, you should choose Part D prescription drug coverage 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 your State Health Insurance Assistance Program (SHIP). Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
When choosing a plan, make sure to ask the following questions:
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.
What are the costs associated with this plan? Medicare’s Plan Finder tool provides an estimated out-of-pocket cost for the year for each plan, based on your medications and dosages.
Are my pharmacies preferred and in-network? You will pay less at preferred in-network pharmacies.
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. Medicare’s Plan Finder tool includes plans’ star ratings.
New in 2023! While comparing plans, it may be helpful to know that starting in 2023 all Part D plans will cover vaccines at no cost to you and will cap your monthly insulin costs at $35, due to the Inflation Reduction Act.
Next, it’s important to understand when you can change your Part D prescription coverage.
You can make changes to your coverage during Medicare’s Open Enrollment Period, which spans October 15 through December 7 each year. Plans may change their costs and the drugs they cover from year to year. 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 your SHIP to see if you qualify for an SEP. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
Finally, know how to change plans.
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 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. You can also change plans using Medicare.gov, including with the assistance of a SHIP counselor, if needed.
Still have questions?
Your SHIP is here for you! You can contact your SHIP for any other Medicare-related questions or concerns you have. SHIP counselors are government-funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
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