The Importance of Re-Evaluating Your Medicare Prescription Plan Coverage

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ICCF — Medicare Prescription Plan Coverage

Medicare Open Enrollment, the period when you can make changes to your plan, begins Oct. 15 and ends Dec. 7.

If you’re considering changes to your Medicare plan, this nearly eight-week period is the time to do your due diligence and decide what coverage best meets your health care needs. For seniors age 65 and older who are covered by Medicare, open enrollment presents an opportunity to evaluate whether your existing prescription drug coverage still works and whether there are ways you can reduce your out-of-pocket health care costs.

The Basics of Medicare Coverage

Medicare includes four distinct plans. Part A is standard Medicare coverage that acts as hospital insurance. Part B acts as medical insurance and covers preventive and medically necessary services. Part C is a health plan in which an HMO or PPO manages Part A and Part B benefits and covers prescription drugs, and Part D is Medicare’s prescription drug benefit.

Part D supplements standard Medicare, and beneficiaries must opt to enroll in this plan when they first sign up for Medicare coverage. Unfortunately, many people don’t understand the differences between plans. According to a 2013 UnitedHealthcare survey, most adults don’t understand what Medicare Parts A, B, C and D cover and 70 percent of Baby Boomers say they have a fair to poor understanding of Medicare.

Choosing the Right Part D Plan

Even if you’ve already signed up for the prescription drug benefit, the details can be confusing or may change this year. If you already have Part D prescription coverage, you should research several things during open enrollment to determine whether you want to stick with your current coverage or choose a different plan. Your plan should send you information right before open enrollment gets underway that details if there will be changes to the cost, coverage, health care providers or pharmacies in your network. This information usually is contained within documents called the “Evidence of Coverage” (EOC) or an “Annual Notice of Change” (ANOC). Thoroughly review these materials to see if any of the potential changes I mentioned are outlined in the documents. If they are, you have a decision to make. If the out-of-pocket costs now will be too high or if your specific prescriptions are no longer covered, it might be best to shop around for another plan or to decide whether you’re comfortable having your doctor change your prescriptions to lower cost generic drugs, which can reduce your out-of-pocket costs.

It’s critical to evaluate your plan every year because prescription formularies are updated annually or twice a year. This is significant to Medicare beneficiaries because routine prescription drugs can change formulary tiers with different carriers during open enrollment. A pharmacy network also may fall out of network, so you need to review the materials from your plan just in case this happens. Many beneficiaries join a prescription drug plan, but the list of medications changes over time. Some beneficiaries may not be aware of these updates because they dismiss important communications announcing premium or benefit changes since they receive an onslaught of marketing communications about Medicare Open Enrollment during this time of year.

Don’t let this mistake prevent you from getting the coverage you need. Go to and use the Plan Finder Tool to get more information about available Part D coverage plans. You also can find information on the site about different health care providers, hospitals and how to better manage your out-of-pocket health care costs. Call 1-800-MEDICARE to get Medicare plan information and compare plans, as well.

Use this time wisely to decide what health care plan is right for you. If you have questions, don’t hesitate to call your provider and get answers before you make a decision. As always, ICCF’s trained insurance professionals can help you navigate Medicare’s open enrollment process. Please contact us with any questions that you may have.



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