What to Do During Medicare Open Enrollment

Do I need to do anything during the Medicare open-enrollment period this year? I’ve been happy with my Part D prescription-drug plan.

You will automatically keep your Part D coverage if you don’t make any changes to it during open enrollment, which runs from October 15 to December 7 for 2014 plans. But it’s a good idea to shop around again for Medicare Part D prescription-drug plans and all-in-one Medicare Advantage plans, especially if your health or medications have changed. Even if your premiums haven’t risen much, your out-of-pocket costs could change significantly.

Many Part D plans have increased premiums, boosted co-payments and changed the pricing tiers for prescription drugs. A number of plans have four or five tiers of drug pricing, and your out-of-pocket costs could go up if the insurer moves your drugs from one pricing tier to another. If a medication moves from a preferred to a non-preferred brand-name drug or specialty drug, for example, you may have to pay as much as 25% of the cost yourself. Some plans even have two pricing tiers for generic drugs, charging a higher co-payment for non-preferred generics.

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One of the biggest changes in recent years is the growth of preferred pharmacy plans. More insurers are introducing low-premium versions of plans that also charge lower co-payments if you buy your drugs through certain preferred or mail-order pharmacies. The Humana Walmart Preferred Rx plan, for example, charges a monthly premium of $12.60 and co-payments of just $1 for preferred generics at Walmart and Sam’s Club pharmacies, and $0 for generic drugs through the RightSource mail order pharmacy, but a $10 co-payment if you buy from non-preferred network retail pharmacies. Tier 3 preferred brand-name drugs have a 20% coinsurance at Walmart and Sam’s Club pharmacies and at the RightSource mail-order pharmacy, but a 25% coinsurance through non-preferred network pharmacies. (Co-payments are a fixed-dollar amount that you pay for each prescription, coinsurance is a percentage of the cost that you must pay.)

To shop for a Part D prescription-drug policy or just check out your options, go to Medicare.gov’s Plan Finder and type in your zip code (or your Medicare number for a personalized search), drugs, dosages and up to two pharmacies near your home. The tool lets you know if there is a generic alternative.

Click on “prescription drug plans” for Part D plans and you’ll see information for all of the plans available in your area. Look at the monthly premiums, deductibles and co-payments, but focus primarily on the “estimated annual drug costs” column, which includes the premiums, deductibles and co-pays for your specific drugs and dosages. Also look at the plans’ star ratings, which assess the Part D plans’ customer service, complaints and member satisfaction.

You can compare up to three plans and see where to find more information about each plan’s cost and coverage. You’ll also see a list of the plan’s network pharmacies in your zip code and how much you can save by using a mail-order pharmacy.

For more information about shopping for a plan for 2014, see Time for Medicare Open Enrollment. You can also get assistance shopping for a Part D plan through your local State Health Insurance Assistance Program (SHIP); call 800-633-4227 or go to www.shiptalk.org for contact information. You may also want to review the plan’s information on the insurer’s Web site before signing up for the new plan. The Medicare.gov Plan Finder information was delayed because of the government shutdown and most of the information on the site was updated by October 15, but it’s a good idea to double check the information with the insurer’s Web site, at least when shopping in mid-October.

Note that Medicare open enrollment is not related to open enrollment for the state health insurance marketplaces. Those exchanges are only for people who are under age 65 and not enrolled in Medicare. See Changes in Medicare for 2014 for details.