by Barbara Nevins Taylor
I am not smiling because I’m in the process of changing my Medicare Part D drug plan. All the negatives come into play: not the way I want to spend time, cumbersome process, and you must pay attention to the details.
The AARP MedicareRX Preferred (UnitedHealthcare) plan I now have does not cover the one medication I use. A doctor’s letter got me an exemption and coverage for 2015. But it turns out that I can get cheaper insurance, and pay less over the course of a year if I change insurers for 2016, and I don’t have to beg the insurer to cover the medication.
Because insurers don’t necessarily cover the same drugs from year to year and change what they call the “formulary,” or list of drugs covered, Fred Riccardi, Director of Client Services of the Medicare Rights Center, suggests reviewing what your plan offers.
“We recommend that everyone review your existing drug plan and be cognizant of any changes the insurer makes for the coming year,” he says
Insurers list the drugs they cover in a brochure, or letter, they send to us called the Annual Notice of Changes. Riccardi says you need to review the list and, “If you can’t find your drug call the insurer.”
If the insurer won’t cover your medication(s) in 2016, you can change your Medicare Part D, or Medicare Advantage program, which generally covers medication, from October 15, 2015 to December 7, 2015 for coverage in 2016.
In my case, I began to try to figure out which new insurer to choose. Medicare.gov tries to make it easy to compare and change plans. It offers an online tool, but you must follow the prompts and answer the questions.
The Medicare Rights Center’s Riccardi points out that when you go on to the site, you can do a general search and a personal search. He suggests, “If you put in your personal information it will show you your current plan and whether you receive help from the government.” That information will help you as you move along through the prompts.
You can navigate the site easily, but plan to spend some time with it.
Tips For Using Medicare.Gov
1. The site will ask what kind of Medicare you have. If you have Part D, you are likely to have Original Medicare and a separate Medicare drug plan.
2. It will also ask whether you get financial aid from the state or another source to pay your drug costs. Make sure you know.
3. Then the next page will ask which drug plan you have now and will provide a list. Make sure you know.
4. The next page asks you to type in the names of your drug(s). You need to know the name of the drug, strength, how often you use it, and how often you refill the prescription.
5. In my case, it offered a generic replacement.
6. The site leads you to a list of pharmacies within your zip code. You can expand the list by expanding the mileage beyond your zip code. You’ll find that prompt above the list of pharmacies.
7. Then it offers a confusing panel with three choices. If you use Part D, then you check Original Medicare with drug plan.
8. Finally, you get to the list of drug plans. But it may confuse you at first by offering information about your current plans. It will show your drug plan and original Medicare and how much you pay for each.
Scroll down to look at the plans available to you.
9. The chart lists the most economical plan first. The column on the left gives you a total cost of what you’ll pay for the year and that includes your premiums, deductibles and copays if they apply. Compare it to your current plan up above.
“We always remind that it’s not the cost of the monthly premium, it’s also about your specific drug coverage,” Riccardi says.
10. Look at the next sections carefully. They show the monthly premium, deductibles, copays and coinsurance each insurer requires. It will also tell you whether the insurer covers your medication(s) and if it has restrictions. You have click on the “yes” to find out exactly what restrictions the insurer puts in place.
When you click yes, you can see whether the insurer requires prior authorization or whether you have to take another medication first before you can move on to the medication your doctor prescribed. They call this “step therapy.”
10. It also shows the star rating Medicare gives each plan based on consumer surveys and the practices the insurer follows.
11. Compare the costs to determine what works best for you. You may have a choice between a lower annual deductible and higher copays. So keep a calculator handy to do the math. Riccardi says, “You want to balance the cost of the coverage and the premium with what the plan covers.”
Ask your pharmacist, if you don’t use a mail order company, which insurer delivers with the least hassle.
12. Before I signed on with a new insurer, I made a list of the possibilities and took it to my neighborhood pharmacy. I asked which insurers were the easiest to deal with, and the pharmacist ranked them in order.
I also stopped at a local CVS pharmacy and asked a pharmacist there. She said, “Oh. They are all the same. If they deny insurance, we call them immediately.”
Still, I think you might want to get a range of opinion.
Once you enroll in a new program, Medicare automatically notifies your 2015 insurer.
If you have questions, call Medicare directly at 1-800-633-4277. The prompt system will annoy you, but once you get past it the people on the phone cheerfully assist you.
WATCH THE VIDEO!