Four Medicare Tips from Pharmacists to Help You During Open Enrollment
Medicare Open Enrollment runs October 15 to December 7 and offers beneficiaries enrolled in Medicare Advantage (Part C) and stand-alone Medicare Part D plans (Part D) a chance to review and make changes to their healthcare and prescription drug coverage. Do you know your plan for this Open Enrollment period? While you and many other beneficiaries may be satisfied with your coverage, changes in drug formularies, premiums, and out-of-pocket costs can be important to keep in mind.
At Rainmakers, our pharmacists combine clinical insight with deep knowledge of Medicare Part D policy to assist our clients in administering their Medicare Part D plans. Here are four tips from our pharmacists to help you get the most out of your Medicare Part C or Part D plan this enrollment season.
1. Don’t Ignore the Annual Notice of Change (ANOC):
By September 30, your current plan will have sent you an Annual Notice of Change (ANOC). This document summarizes changes for the coming year, starting on January 1, which includes. drug formularies (i.e. list of covered drugs), co-payments, deductibles, premiums, and other elements of coverage may change from one year to the other.
Tip: Compare your current medications against the updated list of formularies. Even small changes can impact your costs or coverage.
2. Use the Medicare Plan Finder Tool:
The Medicare Plan Finder Tool is a powerful resource to compare plans based on your medications, location, and preferences. It allows you to review multiple plans offered in your area as it relates to premiums and out-of-pocket costs.
Tip: Have your Medicare number and your medication list ready. You can see estimated costs and coverage side-by-side. For extra help, reach out to your state’s SHIP (State Health Insurance Assistance Program) to assist with Medicare enrollment, coverage changes, and questions related to the Medicare program.
3. Factor in the New $2,000 Out-Pocket Cap:
Beginning in 2025, the Inflation Reduction Act introduced a $2,000 annual cap on out-of-pocket costs for covered prescription drugs. Medicare beneficiaries can choose to pay their co-payments for drugs as they go, or enroll in the Medicare Prescription Payment Plan, which allows beneficiaries to divide their out-of-pocket drug costs over the plan year.
Tip: For those whose income is below $23,000 a year, you may qualify for extra help to assist with insurance premiums, deductibles, and co-payments.
4. Watch Changes in Pharmacy Networks and Prior Authorizations
Even if your plan’s premium stays the same, pharmacy networks and prior authorization rules may change.
Tip: Make sure your preferred pharmacy is still in-network and check if any of your medications now require prior approval.
New to Medicare? Don’t Forget to Add Part D Coverage
If you’re enrolling in traditional Medicare for the first time, you must sign up for a Part D plan during your Initial Enrollment Period. If enrolling in a Medicare Advantage plan, your prescription drug coverage is included in these plans which provide integrated services. This is a seven-month window that begins three months before your 65th birthday. If you miss it and don’t have other prescription drug coverage, you could face a late enrollment penalty.
Tip: Already enrolled in Medicare? You can still add, drop, or switch Medicare Advantage or stand-alone Medicare Part D plans during Open Enrollment.
Medicare Open Enrollment is your chance to manage your healthcare and prescription drug coverage. Taking the time to review, compare, and choose coverage may yield better coverage for less money.
Rainmakers Strategic Solutions
Rainmakers Strategic Solutions LLC (Rainmakers) is a certified 8(a), economically disadvantaged woman-owned small consulting firm, founded in 2008 to provide expertise and highly practical solutions in support of the government and commercial sectors. Rainmakers’ principals are respected professionals with demonstrated success for clients facing evolving requirements and constituent needs. We develop, implement, and improve programs by applying insightful methodologies and delivering innovative results that address and simplify complex issues, streamline processes, and reduce costs. We have a genuine focus on achieving and maintaining an impeccable business relationship with our customers and supporting them in their efforts to improve processes. Client satisfaction is our most valuable asset and exceeding our customers’ expectations is our primary goal. For more information about our key cornerstones—excellence, passion, and knowledge—visit www.rainmakerssolutions.com, call (443) 348-8067, or connect with us on our social media channels:
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