Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies as a standalone prescription drug plan (PDP) for those enrolled in Original Medicare. Sometimes a Part D plan's costs change or the plan no longer covers your medications. Today I will discuss how you can review your current plan, or choose to enroll in a new Part D plan. The goal is to ensure you have the lowest cost coverage that meets your prescription needs.
Take an inventory
The chart above (click to enlarge) shows all of the Medicare Part D plans offered in Alaska for 2023. Before you start looking at plans, make sure you know the prescriptions you take, the dosages of each, and the pharmacies you usually use. To compare different plans available in your area, you can use Medicare's Plan Finder tool at http://www.medicare.gov/plan-compare. For assistance comparing plans, you can call 1-800-MEDICARE (1-800-633-4227). You can also contact one of the Certified Medicare Counselors at the State of Alaska's Medicare Information Office by calling either 800-478-6065 or 907-269-3680. We will be happy to help you select the best plan. When choosing a Part D plan, make sure to ask the following questions:
• Does this plan cover my drugs? You should also find out if there are any restrictions on your covered drugs, such as prior authorization, step therapy, or quantity limits.
• What are the costs associated with this plan? The Plan Finder tool provides an estimated out-of-pocket cost for the year for each plan, based on your medications and dosages.
• Are my pharmacies preferred and in-network? You will pay less at preferred in-network pharmacies.
• What is the plan's star rating? Medicare uses a star rating system to measure how well plans perform in different categories, like quality of care and customer service.
While comparing plans, it may be helpful to know that starting in 2023 all Part D plans will cover vaccines with zero cost-sharing and will cap monthly insulin cost-sharing at $35.
Making changes
You can make changes to your coverage during Medicare's Open Enrollment Period, from Oct. 15 through Dec. 7. Part D plans may change their cost and formularies from year to year, so it is important to review your plan notices to learn if prices will change and if your drugs will still be covered next year. When you make a change during the Open Enrollment Period, your new plan will become effective on Jan. 1.
You may also make a change to your Part D plan if you qualify for a Special Enrollment Period (SEP). For example, those enrolled in Extra Help, the federal program that assists with drug costs, have SEPs each year to change their drug coverage. When eligible for this SEP, your new plan will become effective on the first day of the next month following the change.
Your Part D prescription drug plan typically sends you a statement after you receive your prescriptions. This is called your Explanation of Benefits, or EOB. It is important to remember that an EOB is not a bill. It tells you how much your provider billed, the approved amount your plan will pay, and how much you may owe your provider. Compare your statements to your own records. You may prefer to use the "My Health Care Tracker" pamphlet available from the Medicare Information Office.
It is important to read your EOB soon after you receive it for accuracy. If you think there has been a billing error, first call your Part D plan to try to get it corrected. If the potential errors are not corrected, if you have additional questions, please call Senior Medicare Patrol professionals at the Medicare Information Office. The SMP program empowers and assists Medicare beneficiaries, their families and caregivers to prevent, detect and report health care fraud, errors and abuse.
Ready to help
For any Medicare related questions, please feel free to contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program.
If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office.
Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.
