2021 Medicare open enrollment for current beneficiaries
It’s open enrollment for current medicare beneficiaries. From October 15, 2020, through December 7, 2020, current Medicare beneficiaries can make changes to their existing Medicare Part D coverage for the 2021 calendar year.
Given that prescription drug costs can be burdensome for many, we encourage existing Medicare enrollees to review their existing plan and options during this 2021 open enrollment period.
How to ensure you have Medicare Part D coverage that meets your needs
When reviewing the appropriateness of your current prescription drug (Part D) plan, please take note of the following:
Covered Medications: Part D plans are permitted to change the medications they cover each year. This means it’s very important to double-check whether Medicare will cover your current medications as well as any anticipated new prescriptions. If you find a meaningful gap in your coverage, then we encourage you to explore whether another Part D plan provides you with the coverage you need. You can learn more here.
Premium Prices: Premiums tend to increase over time. Therefore, we encourage you to review whether your current plan is still appropriate for your coverage needs so that you are not overpaying based on your personal situation. While any changes you make to your plan won’t go into effect until January 1, 2021, any decisions to change plans must be made before the end of the enrollment window.
Copayments and Coinsurance: Part D plans use tiered cost-sharing, which causes some plans to change their beneficiaries’ out-of-pocket costs. Most plans will have two tiers for generic drugs, two tiers for brand-name drugs, and one tier for high-cost specialty drugs. Medications in each tier have different out-of-pocket costs. This means it’s important for you to review whether your medications will cost more in the upcoming year and how that may impact your finances.
Deductibles: While most Part D plans charge a meaningful deductible, some plans charge a smaller one. However, even if a plan offers a lower deductible, it can still translate into higher out-of-pocket costs when you factor in co-pays or plan restrictions. It’s important to calculate your estimated total costs for your plan to ensure it fits in with your budget and medical needs. We can assist you with determining your total costs in order to help you determine whether your current plan is the best option for you.
Preferred Pharmacies: The majority of Part D plans offer lower cost-sharing requirements if prescriptions are filled at selected network pharmacies. The reduction in co-payments can exceed 50%. We encourage you to take the time to review whether your current pharmacy is part of the network of plans with the preferred cost sharing.
Medication Restrictions: Some plans require prior authorization before covering certain drugs or require patients to try a lower-cost drug before a more expensive one. Be aware of any restrictions in your current or prospective Part D plan so that you can proactively reach out to your physician to facilitate the paperwork to request a prior authorization approval if you want to continue with a medication that is not approved. These approvals are typically valid for one year. This means that you will need to renew any existing prior authorizations you have in place. Otherwise you will need to pay in full for the prescription, which can become costly for certain medications.
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