Questions about Medicaid Part D Open Enrollment

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Tracie Sullivan

Tracie Sullivan, Grassroots Advocacy Manager at the COPD Foundation manages the COPD State Advocacy Program, a grassroots initiative that encourages everyone in the COPD community -- patients, caregivers, health care providers, and students -- to come together to lobby on behalf of the 30 million Americans living with the disease.

It is that time of year again, where open enrollment for health insurance coverage is available. Trying to decide what health insurance plan is right for you can be a difficult choice to make. You may be asking how to do I sign up? Do I qualify for specific programs? What should I expect once I enroll? This article will help to break down the open enrollment process for the Medicare Part D program and provide you with tips on finding the right plan for you!

What is Medicare Part D?

Medicare Part D is a prescription drug benefit program, which is an optional United States federal government program to help Medicare beneficiaries pay for self- administered prescription drugs through prescription drug insurance premiums. Simply put, it is a government program that helps consumers pay for their prescriptions.

Am I eligible to enroll in Medicare Part D?

You are eligible to participate if you already have Medicare Part A and/or Part B. About two-thirds of all Medicare beneficiaries are enrolled directly in Part D if they have already enrolled in Part A and/or Part B, or if they receive their medical coverage through the Veterans Administration (VA). You can also enroll if you live in a service area of a Medicare Part D Prescription Drug Plan.

How do I decide which plan is right for me?

Start off by making a list of any current medications you take. Then compare your list of prescriptions with each plan’s “formulary” or drug coverage list. This is very important, because if a medication you are currently taking is not covered by your plan, you will be expected to pay the full marketplace value of that prescription. For example, the marketplace value of one vile of Humara, a common medication for psoriasis, arthritis, and crohn’s disease, without being on a drug coverage list for an insurance plan, could be as high as $2,400 per shot per month for out of pocket expenses for patients.

Depending on what state you live in, you may also be able to utilize the help of a healthcare navigator who can individually work with you to compare plans and provide you with the best options based on your healthcare needs. To find a healthcare navigator in your area, click on the search tool here.

Can I get an estimate of how much my plan and prescription expenses will be per plan?

Yes, if you head to www.medicare.gov and click on the “Plan Finder Tool”, you will be allowed to compare coverage and costs with other plans in your area. This tool can also help you to provide an estimate of your total monthly costs over a 12-month period for each of the plans you are considering. It also has a great tool, where you can enter in any medications you are taking, to factor in plan coverage and pricing options.

If I enrolled in a Medicare Part D plan last year, will my coverage remain the same?

Most likely this will not be the case, as the majority of insurance plans fluctuate from year to year. Prior to open enrollment, your insurance company is required to notify you of any changes to your current plan by mail through an “Annual Notice of Change/Evidence of Coverage Letter”. If you did not receive this letter, call your plan immediately and they will send you a copy or talk with you over the phone about changes in coverage.

Most common plan changes can include differences in monthly premium payments, annual deductible amounts, co-payment or co-insurance, the list of drugs covered, and/or prior authorization drug and treatment requirements. However, even slight changes could make a significant impact on your payments, and your access to daily medications; thus, following up with your insurance provider is a great step to make!

How do I sign up, and when will my coverage begin?

You can sign up for Medicare Part D anytime during the open enrollment time of October 15th-December 7th. After December 7th, you will no longer be allowed to enroll or switch insurance plans unless a significant life event occurs (loss of employment, income changes, etc.), so make sure to give yourself enough time in advance to prepare. To enroll in a new plan, you can either directly call the new plan you want to enroll in, call 1-800-MEDICARE or visit www.medicare.gov. Your new coverage will begin on January 1st, 2019.

What happens after I enroll?

Once you enroll, you will receive a welcome letter and a prescription card from the plan in the mail within several weeks. If you do not receive anything, please contact your plan right way to confirm that you are enrolled.

Additional Resource Links:

http://medicarerights.org/fliers/Medicare-Advantage/Medicare-Advantage-Plan-Questions.pdf

http://medicarerights.org/fliers/Part-D/Comparing-Drug-Plans.pdf

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/changing-medicare-coverage/six-things-to-know-about-fall-open-enrollment

5 Comments



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  • I would like to thank Tracie Sullivan for all the hard work she does. Tracie is a beautiful person!! Yay Tracie!
    Reply
  • I've been enrolled in a Medicare supplement RX plan for several years. Since then I've had added medical problems that have required new medications! It's my understanding that if I want to switch to another plan I will be required to take a physical. I didn't have to when I initially signed up.

    If I switch plans, and have the physical, how much will they raise my premium? I'm sure another plan, that paid for more of my current medications, would really help out. I've had to pay $350.00 for Symbicort, and $170.00 for Spiriva while in the doughnut hole. That doesn't leave much for other medications.

    Thanks for any insight. It sounds like there is a way to get around the "pre-existing" coverage rates if you switch plans.
    Reply
    • That is a great question, I hope they talk about it. To help out a bit, I buy the equivalent of Symbicort called Foracort from AllDayChemist, many of us here use that site. I have never had a problem with their products. If you buy 3 inhalers the cost is about $16.00 each plus shipping. Something to consider as you go through the donut hole.
      Reply
  • I also would like to know about the implications if any of switching providers. I just joined this year and I know I had a limited period of time to sign up (I think 6 months), where my pre-existing condition would not be an issue. Going forward, will my pre-existing condition have an impact should I decide to change plans?

    Thanks

    Reply
    • I ccould be wrong, but I think you're confusing Part-D with supplemental health insurance. With the Original Medicare, they are separate. Changing Part-D plans shouldn't trigger additional qualifications.
      If you are in a Medicare Part-C, which includes both, then that may be an issue.
      ed
      Reply

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