Over the next three weeks, adults 65 and older will make several decisions as they sign up for Medicare.
The Medicare open enrollment deadline is Dec. 7. Many adults are currently considering which prescription drug plan is right for them. There are two ways to get drug coverage, a Medicare prescription drug plan, known as Part D, or a Medicare Advantage Plan, known as Part C.
Pritpal Virdee, the CEO of Smart Insurance, answered questions about what enrollees should consider when signing up for a prescription drug plan.
How can prescription drug plans change from year to year?
“Everything changes every year, and that's where you, as a beneficiary who is looking to enroll in one of those plans, have to look at what your out-of-pocket cost is going to be,” Virdee said.
Every year, an insurance company submits its latest prescription drug plan to the government for inspection. Companies will regularly change their deductibles, premiums, copays and drugs they cover.
If you're in an existing plan, your insurance company should have sent you information on any changes it made. If you did not receive that information, you should contact the company and ask about any changes you should expect.
What are some common mistakes people usually make when signing up?
“Say I'm a senior who's been used to going to Joe's Corner Pharmacy for 40 years — make sure that Joe's pharmacy is in the network for the plan you're signing into because if he's not, he's going to have a higher copay for you for the same drug you could get at a Walgreens or another store cheaper,” Virdee said.
Virdee said adults should find out not only about a plan's premiums and deductibles, but also what the copay will be on generic and nongeneric drugs.
Some companies offer a $0 copay with certain “preferred” generic drugs or “preferred” brand-name drugs. If you're taking three or four prescriptions, it's important to know how much the companies cover.
Also, more companies are partnering with pharmacies and building a network of preferred pharmacies. It's important to find out if the plan you're choosing has your pharmacy in its network, Virdee said.
What's the estimated cost if a person doesn't sign up?
It's estimated that an adult who has been on Medicare a few years takes 40 prescriptions a year, spending about $2,200 in drugs, Virdee said.
“So you can see what the savings are,” Virdee said. “If I had 40 prescriptions a year and 50 percent of them I could get at a preferred pharmacy for $0, I'd save a lot of money.”
How often can enrollees change plans?
Once you sign up for a plan, you stay in that plan for a year, unless you have a special circumstance, such as moving to an area where your plan isn't offered.
Virdee said if you find that your plan is set up in a discriminatory manner, you can file an appeal through the federal government to change plans.
A plan is discriminatory when it has a lack of appropriate drug classes to treat certain diseases, a lack of sufficient drugs in a therapeutic class, inappropriate tier placement that would discriminate against a group of beneficiaries, or missing drugs that would cause discrimination, according to the Centers for Medicare and Medicaid Services.
What are the resources available to help choose the best plan?
The state Insurance Department offers free Medicare counseling through the Senior Health Insurance Counseling Program. The program offers free help for Medicare beneficiaries, their representatives or people soon to be eligible for Medicare. The number is (800) 763-2828.
The Medicare website, medicare.gov, also has a significant amount of information about prescription drug plans. On the Medicare website, you can enter in the prescriptions you take and your ZIP code, and the website will calculate which plans are best for you. You can also call (800) MEDICARE, or (800) 633-4227 for assistance.