Medicare Part D Open Enrollment is coming. Are you ready?

Published Aug 26, 2018 at 9:00am

The Medicare Part D Open Enrollment period is about to begin.

For many Oneida County residents who are among the 10,000 U.S. citizens who turn aged 65 every day, the term Open Enrollment may be an unfamiliar one.

Open Enrollment is the time when you can make a number of changes to your 2019 Medicare prescription drug coverage. This year this period will run from Oct. 15 through Dec. 7.

During the Open Enrollment period you can move from Original Medicare to a Medicare Advantage plan or dis-enroll from an Advantage plan and go back to Original Medicare with a separate or “stand-alone” prescription drug plan.

You can also dis-enroll from your current Medicare Advantage plan and switch to a different one.

• Understanding the Medicare program.

Medicare consists of specific parts. Part A provides hospital coverage, while Part B covers a variety of medical services including visits to your doctors.

Taken together, these two-parts form what is termed Original Medicare. Part D, which is the focus of the annual Open Enrollment period, provides you with prescription drug coverage.

If you are enrolled in Original Medicare you must also be enrolled in a Part D plan.

Medicare Advantage plans are the alternative to Original Medicare.

Medicare Advantage plans generally cover additional services that are not covered by Original Medicare and usually include prescription drug benefits. In this case, when you choose a Medicare Advantage plan you are also making your Part D drug coverage choice.

• Understanding your drug plan.

In choosing the drug coverage that is right for you, there are two terms that you need to understand, formulary and tier.

A formulary is the list of drugs that each plan covers. Second, most Medicare drug plans place all the drugs into 3-5 different tiers.

Drugs in each tier have a different cost. As a general rule, if a drug is in a lower tier, your copayment is lower.

If your physician prescribes a new drug for you, always make sure it falls within the formulary of your drug plan as well as the lowest tier possible. If the drug is too expensive, your physician may be able to prescribe an equally effective lower cost alternative.  

• Obtaining drug coverage.

As noted above, there are two basic ways to obtain Part D coverage:

The first way is to sign up for a Medicare Prescription Drug Plan, sometimes called “PDPs.”Using this method, which is the most common way of obtaining coverage, you select a drug plan that adds coverage to Original Medicare.

Many retirees obtain this type of coverage through plans provided by their former employees. 

The second way is by enrolling in a Medicare Advantage Plan, sometimes called Part C, or some other equivalent health plan which offers prescription drug coverage.

For example, if you are a retired veteran who is covered by VA health care you are not required to enroll in a Part D plan.  

• Should I sign up for the cheapest plan?

The monthly premium is only one of the factors you need to consider in choosing the drug plan that is best for you.

For example, a low-cost plan may have higher out-of-pocket costs and end up costing you more than a plan with a higher premium.

Drug prices vary greatly from one plan to another and depend on their formularies and the tier your drugs are in.

The actual out-of-pocket costs to you depend upon a number of other factors. You will need to price out the prescriptions that you take — including the dosage. Again, the cheapest plan is not always the best plan for you.

• Always consider all of your options.

Before you make a decision, learn how Part D works with your other drug coverage.

For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA) or the Indian Health Service.

If you have, or are eligible for, other types of drug coverage, read all the materials you get from your insurer or plan provider.

Compare your current coverage to Medicare drug coverage. Speak to the plan administrator to make sure you understand your options.

These are types of issues that you can speak to a HIICAP counselor about. More about HIICAP later. 

• Using Plan Finder.

Until your drugs are entered into the online Medicare Plan Finder, there is no way of knowing at a glance which of the Part D plans will work best for you.

Plan Finder is an Internet tool that lets you view and compare your health and drug coverage options and identify which plans cover your prescriptions at the most affordable cost where you shop.

You can also enroll in the Part D or Medicare Advantage Plan using Plan Finder.

The Plan Finder calculates the best choices for you based upon cost, coverage, and convenience.

You can access the Plan Finder from your home computer at www.Medicare.gov. Plan Finder is still not completely “user friendly” but has been improved dramatically over the years. 

• Help is always available in Oneida County to answer all your insurance questions.

Whether you are new to Medicare or have been covered for a number of years,

The Oneida County Office for the Aging/Continuing Care/NY Connects Health Insurance Information, Counseling and Assistance program (HIICAP) offices can answer all your Part D, as well as Original Medicare and Advantage Plan questions.

Many try their hand using Plan Finder and then work with a trained HIICAP specialist to make a final choice. These services are provided at no cost to all Medicare beneficiaries. HIICAP offices are found at the following locations:

• Ava Dorfman Senior Citizens Civic Center, 305 E. Locust St. with hours of operation on Tuesday and Thursday from 10 a.m. to 2 p.m.

While consumers are seen on a “first come, first served” basis you may call the Dorfman Center at 315-337-1648 to see if there are long wait times.

• North Utica Senior Citizens Community Center, 50 Riverside Drive, Utica with hours of operation on Monday, Wednesday and Friday from 10 a.m. to 2 p.m.

Consumers are counseled on a “first come, first served” basis. However, if you want to call ahead to see how busy the office is you may call the Center’s HIICAP program at 315-724-8680.

HIICAP services are provided by Oneida County Office for Aging and Continuing Care/NY Connects.

Anyone with questions about HIICAP, including issues with your Medicare Advantage Plan, should call the program directly at 315-798-5456 and press 4 in the choice list.

It will direct you to someone who can assist you.

EDITOR’S NOTE: Dr. William Lane is the owner of William Lane Associates, a gerontological consulting firm based in Homer. He is writing a monthly column on issues related to health insurance for the OFA. He does not sell insurance, work for any insurance company or recommend any insurance products.