Friday, November 25, 2022

When Can I Change My Medicare Prescription Drug Plan

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Do I Have To Reenroll In My Medicare Part D Prescription Drug Plan Every Year

“When can I change my prescription drug plan?” Medicare 101, Myths and Questions #2

En español | If you like your current Part D drug plan, you can remain with it into the following plan year, which begins Jan. 1. You dont have to reenroll or inform the plan that youre staying. But be aware that all Part D plans can change their costs and coverage every calendar year. Therefore, the plan that works best for you this year wont necessarily be your best deal next year. So its in your own interests to carefully consider your options.

As a first step, pay attention to a letter youll receive from your plan in September. This is the Annual Notice of Change that Medicare requires plans to send to all of their enrollees. It informs you of any changes the plan will make for next year including costs benefits service area and which pharmacies can dispense drugs under this plan.

Reviewing the Annual Notice of Change provides you with a basis to compare your current plan with others offered in your area for the following year. You can make this comparison during the annual open enrollment period . You can use the online plan-finder program on Medicares website to identify the plan that covers your drugs at the least out-of-pocket cost, or call Medicare at 800-633-4227 and ask a customer service representative to do the search for you.

Medicare Prescription Drug Plans: Can They Change Their Formularies

Yes, Medicare Prescription Drug Plans can change their formularies. This is why you may not want to just sign up for a plan and forget about it, assuming the coverage will be the same year after year.

Every fall, every Medicare Prescription Drug Plan sends an Annual Notice of Change to every plan member. It may be wise to check your plans ANOC every year to see if your medications are still in the formulary, and whether there have been changes to your out-of-pocket costs.

A Medicare Prescription Drug Plan can change its formulary other times, too, for certain reasons not just in the fall. A plans formulary may change at any time. You will receive notice from your plan when necessary.

What Drugs Are Excluded From Part D Plans

The drugs that are excluded from Part D by Medicare are: Drugs used for anorexia, weight loss, or weight gain Drugs used to promote fertility Drugs used for cosmetic purposes or hair growth Drugs used for the symptomatic relief of cough and colds Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations Non-prescription drugs Inpatient drugs Barbiturates – except when used to treat epilepsy, cancer, or a chronic mental health disorder In addition, a drug cannot be covered under a Part D plan if payment for that drug is available under Part A or B of Medicare, such as drugs administered in a hospital or a physician’s office. Also, each Part D prescription drug plan may have its own specific exclusions.

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Four Ways To Leave Medicare Advantage

Medicare Advantage has become increasingly popular over the last decade. Forty-three percent of all Medicare beneficiaries were in Medicare Advantage plans as of mid-2021, up from just 13% in 2005.

But although enrollment in Advantage plans is rapidly increasing, that doesnt mean everyone is happy with Medicare Advantage, or that its the right option for all Medicare beneficiaries who enroll in it.

To protect Medicare beneficiaries, lawmakers provided escape hatches for Medicare Advantage enrollees who decide for whatever reason that theyd rather be covered under Original Medicare. There are essentially four different avenues available to enrollees who want to leave their Medicare Advantage plan:

  • Make changes during general open enrollment .
  • Switch to Original Medicare during the first year on the Medicare Advantage plan .
  • Switch to Original Medicare during the annual Medicare Advantage open enrollment period . Note that Medicare Advantage enrollees also have the option to switch to a different Medicare Advantage plan during this time.
  • Switch to Original Medicare if a special enrollment period becomes available.

Ready to change your Medicare Advantage coverage? Talk with a licensed advisor now at

When To Enroll & Change Medicare Supplement Plans

Medicare Info

Medicare Supplement Insurance , sold by private companies, helps pay some health care costs that Original Medicare doesnt cover. Policies can include coverage for deductibles, coinsurance, hospital costs, skilled nursing facility costs, and sometimes health care costs when traveling outside the U.S.

If youre considering one of the 10 standardized Medigap plans A, B, C, D, F, G, K L, M, and N its important to get the facts early so you dont miss the enrollment deadline. Heres what you need to know about buying a Medicare Supplement Plan now and making changes in the future.

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Medicare Prescription Drug Plans: A Quick Rundown

You can usually get Medicare prescription drug coverage in either of two ways.

  • From a stand-alone Medicare Part D Prescription Drug Plan to complement your Original Medicare
  • Through a Medicare Advantage Prescription Drug plan. A Medicare Advantage plan gives you an alternative way to get your Medicare Part A and Part B benefits.

Both types of plans are available from private, Medicare-approved health insurance companies.

How Do I Know If I Should Change Plans

Health care and budget needs change over time. If your current plan isnt meeting your needs, you can switch to a different plan or even a different type of Medicare coverage.1

Medicare Advantage and Medicare prescription drug plans send information to members every fall. This is called the Annual Notice of Changes . The ANOC explains upcoming updates to the plans benefit coverage, costs, or service area for the next plan year. When looking at your current and future needs, the ANOC can help you decide if you need a different plan.

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If You Already Have Prescription Drug Coverage

If you already have , you may be able to keep it without the risk of paying a late enrollment penalty if you decide to enroll in a Medicare prescription drug plan later.

Your options differ, depending on which type of existing drug coverage you have:

  • Current employer plan, union plan or retiree plan
  • TRICARE, Department of Veterans Affairs or the Federal Employee Health Benefits Program

If you are covered by a current employer, union or retiree plan and are about to become eligible for Medicare, you should receive a notice from the company explaining how your benefits will change and what your options are regarding Medicare Part D. If you are about to become eligible for Medicare and have not received a notice or did not understand the notice you received, call your former employer or the company that processes your claims.

If at some point in the future your employer, union or retiree plan stops offering prescription drug coverage, you will be able to join a Medicare drug plan without penalty as long as you join that plan within 63 days of the end of your current coverage.

Note: Keep any letter or notice from your employer, union or retiree plan stating that your prescription drug coverage is creditable to use for documentation if you apply for Part D drug coverage at a later time.

Talk to your plans benefits administrator to get more information. If your benefits are not creditable, you may still be able to:

Find A Medicare Drug Plan In Your Area

Medicare doesn’t cover my new prescription drugs. Can I change plans?

Use the online Medicare Plan Finder tool for a list of the stand-along Part D plans and Medicare Advantage plans with drug insurance available in your ZIPcode.16 The comparison tool shows the drugs covered by each plan, cost-sharing amounts, and whether you need prior authorization and preferred pharmacies.

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Need Help With Medicare Prescription Drug Plan Costs

If you are already enrolled in the Medicare prescription drug program, you may be able to receive extra help from the Social Security Administration . Eligible enrollees can get help paying for monthly premiums, annual deductibles, and copayments related to Medicare Part D. To find out if you qualify for extra help and to apply, please visit the SSA website.

When Can I Change Medicare Prescription Drug Plans

Whether youre enrolled in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, there are specific times when you can switch plans.

  • If youre still in your Medicare Initial Enrollment Period, and youve already enrolled in a Medicare Prescription Drug Plan, you can change to a different plan only if you do so before the effective date of the first plan you signed up for.
  • You can generally change Medicare Prescription Drug Plans during the Annual Election Period , also known as the Medicare Open Enrollment Period. This period runs from October 15-December 7 every year. During this time, you can typically:
  • Change from one stand-alone Medicare Part D Prescription Drug Plan to another
  • Change from one Medicare Advantage Prescription Drug plan to another
  • Change from one Medicare Advantage plan to another, regardless whether either plan includes prescription drug coverage
  • Sign up for a Medicare Advantage Prescription Drug plan
  • Sign up for a stand-alone Medicare Part D Prescription Drug Plan

You might be able to make other coverage changes during the AEP.

Do you have questions about Medicare Prescription Drug Plans? Were here to help. Just call eHealth to speak with a licensed insurance agent.

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Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.

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How To Join A Drug Plan

Once you choose a Medicare drug plan, here’s how to get prescription drug coverage:

When you join a Medicare drug plan, you’ll give your Medicare Number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

How To Cancel A Medicare Supplement Plan

Medicare Part D

There is not a required disenrollment period for canceling your Medicare Supplement plan. You may drop your Medigap policy at any time by requesting a cancellation through your insurance company however, if you decide to leave, you may not be able to buy a Medicare Supplement Insurance plan at another time, unless you have a trial right or guaranteed issue right .

Need help choosing a Medicare Supplement Plan? No matter where you are in your Medicare journey, Medicare.orgs information and resources can help make it easy to find the quality and affordable Medicare plan thats right for you. We offer free comparisons for Medicare Advantage Plans , Medicare Supplement Plans , and Medicare Prescription Drug Plans .

Get an online quote for Medicare plans that fit your health care needs today! Or call TTY 711 to get answers and guidance over the phone from an experienced licensed sales agent.

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What Is The Late Enrollment Penalty

The Late Enrollment Penalty is a fee that is meant to encourage enrollment in a prescription drug plan at the point of eligibility. If you are enrolled in a Medicare prescription drug plan, you may owe a Late Enrollment Penalty, if for any 63 days or more after the Initial Enrollment Period, you went without 1 of these:

  • A Medicare Part D Prescription Plan
  • A Medicare Advantage Plan
  • Another Medicare health plan that offers Medicare prescription drug coverage

The Late Enrollment Penalty is added to your monthly Part D premium for as long as you have Part D coverage, even if you change your Medicare Part D plan. The Late Enrollment Penalty amount changes each year. You may also have this penalty if you have a Medicare Advantage plan that includes prescription drug coverage . You can avoid the late enrollment penalty by making sure you enroll when you are eligible and keeping your coverage.

If you qualify for Extra Help due to a lack of income or resources, you can enroll late without a penalty. However, if you lose Extra Help, you may be charged a penalty if you have a break in coverage.

Medicare, not the Cigna Part D Plan, will determine the penalty amount. You will receive a letter from the plan notifying you of any penalty. For further questions or concerns about the Late Enrollment Penalty, call Medicare at 1 MEDICARE or visit www.medicare.gov.

Special Enrollment Available For 5

Medicare utilizes a star rating system for Medicare Advantage and Part D Prescription Drug Plans. Each Medicare contract is assigned a rating of one to five stars, with the best contracts receiving five stars. If you live in an area where a 5-star Part D or Advantage plan is available, you can join or switch to the 5-star plan up to once per year, between December 8 and November 30.

In 2021, there are a total of 28 Medicare contracts nationwide that have a 5-star rating. Two are Medicare cost plans, five are stand-alone Part D plans, and the rest are Medicare Advantage plans.

Most plans do not receive five stars, and in most years, most areas of the country do not have 5-star plans available. For 2021, however, theres a UnitedHealthcare contract with a five-star rating, available in most of the US.

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Medicare Prescription Drug Plans: Should I Change Plans

Only you can decide whether you should change Medicare Prescription Drug Plans. Remember, its not just the plan premium you should consider. Compare deductibles, coinsurance, and copayments too.

Heres one easy way to compare Medicare Prescription Drug Plans. Just enter your ZIP code in the box on this page and click the button beside it. Youll see a list of stand-alone Medicare Part D Prescription Drug Plans available in your area. Click Add Rx Drugs to list your medications. This makes comparing plans even easier, because you can see if a selected plan covers your medications, and for what cost.

Note that from eHealths plan comparison tool, you can click the Medicare Advantage Plans box to display Medicare Advantage plans. The resulting list tells you whether the plan covers prescription drugs. Again, you can click Add Rx Drugs to list your medications.

Consider All Your Drug Coverage Choices

Medicare Supplement: How to Change Your Plan

Before you make a decision, learn how prescription drug coverage works with your other drug coverage. For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs , the Indian Health Service, or a Medicare Supplement Insurance policy. Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options.

If you have other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.

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How To Change Medicare Plans

Be aware that if you want to disenroll from a Medicare Advantage plan and dont want to enroll in another Medicare Advantage plan, you have to notify your plan in writing. However, if you want to change from one Medicare Advantage plan to another or from one Medicare prescription drug plan to another, all you have to do is join the new plan, and you will automatically be disenrolled from the old one.

Also understand that you can generally only change Medicare plans during the Medicare Advantage Open Enrollment Period, Annual Election Period, or a Special Election Period .

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

Changes During Annual Open Enrollment

There are many plan changes that Medicare beneficiaries might want to make from one year to the next.

For most of them, the applicable open enrollment period is October 15 to December 7, with changes effective on January 1. During that timeframe, you can:

  • Switch from Original Medicare to Medicare Advantage, or vice versa.
  • Switch from one Medicare Advantage plan to another.
  • Enroll in a Part D Prescription Drug Plan for the first time
  • Switch from one Part D plan to another.
  • Drop your Part D coverage altogether .

Read more about the four ways you can upgrade your Medicare coverage during open enrollment. And take a minute to read about Medicare enrollment mistakes that could cost you money.

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What Should I Know About Medicare Prescription Drug Coverage

Medicare Part D prescription drug coverage is offered by private insurance companies authorized by Medicare, and each plan may have different coverage requirements and out-of-pocket costs. Before you fill your prescription, you might want to ask your doctor if there is a generic medication or other cheaper equivalent that he or she can prescribe to treat your condition.

Medicare Part D coverage generally favors generic medications. You may pay less out-of-pocket for generic prescription drugs . As mentioned above, each prescription drug plan has a formulary, or a list of covered prescription medications. Formularies can change at any time, but the plan must inform you in writing when they do.

If this is the first time youre filling a prescription for a particular medication, you can also ask your plan. Your plan can tell you:

  • If the medication is covered and what youll pay for it.
  • Whether there are any special requirements you must meet before your benefits apply. For example, some plans require step therapy before they cover a particular prescription drug, which means that your doctor must try less expensive prescription medications to see if you respond before the plan pays for a more expensive one.

If your plan says your prescription drug coverage wont pay for a particular medication, you may also ask for an exception. Your Medicare prescription drug coverage may approve an exception if:

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