Medicare Annual Enrollment period is now underway. So, if you have Medicare, now is the time to re-evaluate your coverage and determine if you need to make any changes to your Part D prescription drug and/or Medicare Advantage plan.
By now, you should have received your Annual Notice of Change from your insurance company. This document shows a comparison between 2014 and 2015 benefits, so it’s a good place to start to assess any changes being made to your plan, including to your monthly premium, co-pays and the plan’s list of covered medications (drug formulary).
Plans and their benefits change every year, so it’s a good idea to shop your options, even if you’re happy with your current policy.
Details vary widely across the country and among the different plans, but here are 4 general trends to watch for during Medicare open enrollment.
1. Higher out-of-pocket costs. Although prices of monthly premiums in 2015 should remain fairly close to those from 2014, you’re likely to see higher costs when you go to the doctor. For example, an analysis by the consulting firm Avalere found that 5% fewer drug plans will come with no deductible next year. Also, fewer plans will provide any financial help when you hit the drug coverage gap known as the donut hole.
Be sure to add up all of the costs that come with the plan. Sometimes the policy that looks cheapest upfront ends up costing you more in the end.
2. Fewer covered medications. Overall, both Medicare Advantage and standalone Part D drug plans will be covering fewer medications in 2015 as compared to 2014. That’s according to an analysis by HealthPocket.com, a free website that compares and ranks all health insurance plans.
There are also more restrictions on the drugs that plans do cover. For example 16% more plans in 2015 will require you to first get authorization from your insurer if you want your medications covered. Quantity limits will also be more common next year than this year.
And in addition to checking costs, make sure you can live with the specific rules each plan requires you follow, and check that there are participating pharmacies conveniently located to you.
3. Changing provider networks. According to the Avalere analysis there will a slight uptick (just 1.5%) in the number of plans that cover only doctors in their networks (HMOs), and 9% fewer plans that allow you to see doctors outside the network (PPOs) and still get coverage. Check carefully to make sure your doctor participates with your plan. Seeing doctors outside your insurer’s network means higher costs.
4. More stars. Medicare Advantage and Part D plans are given anywhere from one to five stars to indicate quality.The number of high quality Medicare Advantage and drug plans have been increasing in recent years, with more plans receiving 4 to 4.5 stars out a possible 5. That’s good news for Medicare beneficiaries. You’ll likely have more high quality plans from which to choose. Try to find one with no fewer than 3.5 stars.
You can find and compare Medicare Advantage and prescription-drug plans available in your area by inputting your zip code on the Plan Finder tool at Medicare.gov.
Medicare Annual Enrollment runs from October 15th through December 7th.
For free personalized help, contact your State Health Insurance Assistance Programs (SHIPS). You can find your local program by visiting the Medicare.gov Medicare Helpful Contacts page.