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5 Things to Check During Medicare Open Enrollment

There’s less than one month left before Medicare Open Enrollment ends on Dec. 7. Remember, unless you qualify for a Special Enrollment Period, this is the only time you can join or switch health (Medicare Advantage) and prescription drug (Part D) plans for the coming year.

If you or a loved one has been affected by a recent natural disaster, your open enrollment may extend to Dec. 31. If you want to request an extended enrollment period, call 1-800-MEDICARE or contact your health insurance company or drug plan directly.

In the meantime, here are 5 things you should check right now, to evaluate whether the plan you’re in or the plan you’re looking to join is the right one for you.

1. Your mailbox

If you’ve been ignoring the marketing mail from plans looking to get you to change, make sure you don’t overlook anything that comes from Medicare or Social Security.

For example, if your plan decided not to renew its contract with Medicare or continue to serve your area, you should have received a notice in October and will get another reminder in November to select a new option.

If you’re receiving Extra Help to pay for your prescriptions, you may receive information about your continued eligibility for this benefit, changes in copayments at the pharmacy, or a notice about selecting a new plan if your plan is being terminated at the end of the year.

If you’re currently enrolled in a Medicare Advantage or Part D plan, you should have received an Annual Notice of Change (ANOC) from your plan in September. Be sure to read the ANOC closely, as it outlines any changes to your costs and coverage in the coming year.

2. Your doctors and specialists

Medicare Advantage plans may limit members to using specific providers. If you want to continue seeing your doctor and any specialists, be sure to check that they are still in the plan’s network. Medicare Advantage plans are required by the Centers for Medicare & Medicaid Services (CMS) to keep their online provider directories updated. People with Original Medicare usually only need to ensure their providers are still accepting Medicare assignment.

3. The drug formulary

Each plan that covers prescription drugs has its own formulary, or list of covered medications. In addition, most formularies have tiers that affect how much you pay for your drugs at the pharmacy. Open Enrollment is the time to check:

  • Whether the prescriptions you take are on the plan’s formulary
  • What tier they fall under (and therefore what your copayment is)
  • Whether the plan places any restrictions on how you can get your medication, such as quantity limits or prior authorization from your provider

4. Your pharmacy

Some plans have negotiated with specific pharmacies to offer discounts to plan members who fill their prescriptions there. If you have a preferred pharmacy, or like to receive your medications by mail, be sure to compare how much you’ll pay for those options when shopping for plans.

5. How much it will cost you in 2018

While CMS has indicated that on average, Medicare health and drug plan premiums will decrease slightly in 2018, you should look beyond premiums to determine actual out-of-pocket costs. Be sure to check for the deductible, copayments, and whether you may fall into the Part D coverage gap (or “donut hole”), which happens when you reach the $3,750 drug coverage limit.

Getting started

If you’re confused about Medicare and need a place to start learning about your coverage options, visit NCOA’s My Medicare Matters® and take the questionnaire to get a free, short report that helps you compare your choices.

You also can compare plans by:

New Medicare cards

One more thing: Beginning in spring 2018, Medicare will begin issuing new Medicare cards. These cards will no longer use your Social Security number for Medicare identification. CMS will mail the cards to the address that you have on file with Social Security, so be sure that address is correct. All Medicare cards will be replaced by April 2019.

Remember that you do not have to do anything to get the new card. If you are contacted by anyone requesting money or your current card information in order to be issued a new card, this is a scam. You should report any fraudulent behavior to Medicare by calling 1-800-MEDICARE.

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About Brandy Bauer

Brandy Bauer is Associate Director of NCOA's Center for Benefits Access, where she helps state agencies and community organizations connect low-income Medicare beneficiaries to benefits.

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