Gather Your Things: A Guide to Open Enrollment [Part 2]

October 6, 2017

by: The My Medicare Matters Team

This article is the second installment in our 2018 “Preparing for Open Enrollment” series. To stay up-to-date on the latest Open Enrollment blog posts, subscribe to our mailing list. For a complete overview of Open Enrollment, check out our “Guide to Open Enrollment” page.

Read the first OEP blog post: “Watch Your Mailbox: Preparing for Open Enrollment [Part One] »

Read the third OEP blog post: “Go Shopping: Preparing for Open Enrollment [Part Three] »

Welcome to Medicare Open Enrollment season! The Open Enrollment Period (OEP) occurs every year from October 15th to December 7th. During OEP, anyone with Medicare can change their prescription drug plan or Medicare Advantage plan for any reason. Now that it’s October, your mailbox is probably brimming with Medicare plan brochures trying to sell you on Plans X, Y and Z.

While one of these new plans might be better than your current Medicare coverage, how do you know for sure? And, why go through the trouble of researching new options if you like the plan that you have? Remember, Medicare plans can change what you have to pay each year as well as what they pay for. To ensure that you still have the best plan for your needs, it is important to check your plan against its competitors each year. Switching to a different Medicare Advantage or Part D plan could potentially save you hundreds of dollars a year. 

To start, there are a few key steps you should take to take to find out if you’ve got the best coverage for 2018. The first step is to review what you have now, how much you pay for it, and what you think you might need next year. This begins with reading through your Annual Notice of Change and Evidence of Coverage (ANOC/EOC) packet, which your current plan should have mailed to you in late September. If you didn’t receive it, call the number on your Medicare card and ask for another, or go online and download a copy.

The ANOC/EOC is the thick packet most people place unopened in a drawer for safe keeping. Don’t be one of this people! This notice is crucial–it’s the only one required by law that details the changes in your plan from 2017 to 2018.

The ANOC/EOC lists any changes in your plan’s fixed drug costs, like your monthly premium and deductible. However, don’t be fooled into keeping your current plan just because a quick glance shows that these costs haven’t increased. Go a step further and answer these questions too:

  1. Are my current prescriptions still on the list of covered drugs (known as a formulary)? The ANOC/EOC isn’t specific enough to detail these types of changes, so make sure you contact your plan and find out if your drugs are still covered.
  2. Are my drugs on a different tier now, with different cost-sharing? Sometimes plans move drugs from a lower tier to a higher tier and what you owe may increase.  If a generic form is available, talk with your doctor about taking the generic–it may lower your costs.
  3. Do any of my drugs have new restrictions, such as needing approval from the plan before getting my medicine? Plans may add prior authorization requirements, quantity limits, and/or step therapy to medications from year-to-year. Plans often add these as safety measures when there are drug interaction concerns, or to verify a disease diagnosis. It is also a way for plans to control costs. Consider whether these new restrictions will work with your preferred prescription drug habits. If not, you may want to use this time to change your coverage instead.
  4. Can I keep using the same pharmacies? Are there changes to the cost of using your pharmacy? In recent years changes to pharmacy networks have been common. There are now at least three categories of pharmacies your plan may contract with as follows: preferred cost-sharing (usually chains with lowest prices), network (mostly chains and lower prices), and out-of-network (may not even take your plan and most costly). If you can no longer use your preferred pharmacies, you may want to consider switching to a different plan.

Most Medicare beneficiaries can change plans from Oct. 15th to Dec.7 if you find a plan you like better for 2018. So gather your ANOC and other materials and start that research now!

**Please note, as a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare & Medicaid Services (CMS) has authorized special enrollment period (start of the incident period – December 31st, 2017) for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This special enrollment allows Medicare beneficiaries affected by these hurricanes to enroll, dis-enroll or switch Medicare health or prescription drug plans. Individuals may contact 1-800-MEDICARE to request enrollment using this special enrollment opportunity.

For more information on how to evaluate your coverage options during Open Enrollment, try taking our Medicare Questionnaire assessment, which can connect you to free professional advice about Medicare from a licensed benefits advisor. And check back on this blog for the next couple months for more Open Enrollment guides and tips, or subscribe to our mailing list and we’ll send the tips right to your inbox.