Each year between October 15th to December 7th Medicare beneficiaries have what is called an Open Enrollment Period (OEP). During this Open Enrollment Period (OEP) anyone who is already enrolled in Medicare can choose to join, switch or drop a Medicare Advantage or Prescription Drug Plan. People wanting to make a change in their Medicare Advantage or Prescription Drug Plan during this period DO NOT have to pass any health underwriting, and their new plan goes into effect the first of the calendar year.
Companies providing Part D Drug Plans and Medicare Advantage Plans to Medicare beneficiaries can change their contracts, coverage and benefits every year. That means the plan you are on this year may not cover the same prescriptions next year. Or the plan could change the pharmacies that they contract with (i.e. their network) or could even add prior authorization requirements before they cover prescriptions.
Despite all these great reasons to get an annual plan comparison done, a recent study by Kaiser Family Foundation revealed that only 3 in 10 Medicare beneficiaries compare their current plan with other Medicare plans during the annual open enrollment period.
Completing a plan comparison does not have to be painful, there are several options available:
- Reach out to a local SHIIP/ SMP Office to schedule an appointment with a trained SHIIP/ SMP Counselors. Visit https://shiip.iowa.gov/find-a-shiip-counselor to find a local office. Most SHIIP/ SMP Offices begin scheduling OEP appointments in mid-September for in person or virtual appointments (via phone or video). Or call our toll-free line 1-800-351-4664 to get the number for your local office.
- Set up an account at https://www.medicare.gov. Medicare.gov is an amazing online tool which lets you add your prescriptions, select the pharmacies you use and then compare plan options. You can find resources to help you run a comparison on our website at https://shiip.iowa.gov/find-resources/medicare-open-enrollment-period, including a short step-by-step video from the Center for Medicare & Medicaid Services (CMS).
- Call Medicare at 1-800-Medicare (1-800-633-4227) and ask for assistance in running a comparison during the OEP. A Medicare Customer Service Representative can provide this assistance over the phone. They are available to call 24/7.
No matter what route you take here are some tips to make sure you get the most from your comparison.
- Make sure you have all your prescription information available. Your comparison will not provide realistic pricing information if you do not have the correct prescription names and doses.
- Ensure you look at pricing available through different pharmacies. Some plans have preferred pharmacies which may provide better pricing. Some people also find savings by using mail order pharmacies. A willingness to explore a range of pharmacies may provide significant savings.
- If you are comparing Medicare Advantage Plans ensure your providers (including any specialists, hospitals and even durable medical equipment suppliers) are in the planβs network.
- If you are completing a comparison with a SHIIP/ SMP Counselor, ask if they can also screen you to see if you are eligible for any programs that assist with covering the costs of prescriptions. There may be federal and state programs available to you, depending on your income and resources.