During the period of October 15th to December 7th, individuals entitled to Medicare have the option to switch or enroll in Medicare Advantage Plans, switch prescription drug plans or enroll back into traditional Medicare. Once a change is made, the choice becomes effective January 1st of the next year.
Here we will discuss some of the things to consider when looking at:
Prescriptions Drug Plans
Although the monthly premium is important when choosing a plan, do not choose a plan on the premium only. Look at the total annual cost which includes deductible and co-payment amounts. Determine what the co-pays are for each prescription, the tier that has been assigned, and make sure they are on the plan’s formulary list, the list of the insurance company’s covered prescriptions. Be sure to verify that the pharmacy you use is in the network of any of the plans you are considering. For the most current information, we suggest contacting your pharmacy and confirm that they participate in the plan you are considering. Because there are many prescription plans available, be sure to visit www.medicare.gov to do a complete analysis of the plans available in your area. Remember, if you are already enrolled in a prescription drug plan and are satisfied with the plan, you do not have to make any changes.
Medicare Advantage Plans (MAP)
These plans are managed by private insurance companies and have their own set of guidelines to follow although they are governed by Medicare. These plans have a specific network of providers, a list of doctors/hospitals that are contracted with the plan, that one must use to receive the benefits of lower co-pays and out of pocket expenses. If you use a doctor or hospital that is not in the plan’s network, the co-pay and out of pocket expenses are higher or, in a worse case scenario, may not be covered at all. Seasonal residents should pay particular attention to the network of providers not only in the area of their primary residence, but in their second residence as well. Some insurance carriers may have prescription drug coverage included in their plan; verify the prescription benefits using the pointers given in the topic discussed above. Finally, compare the overall all cost of the Advantage plan, deductible and annual out of pocket, to the cost of the annual premium for a Medicare supplement; many times they end up being equal in the end.
We understand that these topics can be confusing and that your decision “locks” you in a plan for the year. For more information on these topics or if you have any questions, please call our office to speak with one of our knowledgeable staff.