It’s the time of year to review your Medicare coverage, especially your Medicare Part D Plan which covers your prescription drugs. Open enrollment runs from Oct. 15 until Dec. 7, a seven-week window to think about your health care needs for 2022 and decide whether you should make any changes in your Part D coverage.
Experts urge older adults to take the time to make sure they have the coverage that's best for them.
“It's a question of what people need to think about; about what's most important to them,” says Tricia Neuman, senior vice president and director of Medicare policy at the nonpartisan Kaiser Family Foundation (KFF). For example, she says, taking time to make sure your prescription drugs are covered at the best price "could really mean a difference of hundreds or even thousands of dollars.
You can decide whether to enroll in a Part D prescription drug plan or change plans if you already get your drugs through a Part D policy. Any changes you make will take effect in January 2022.
Neuman says it's unfortunate that the large majority of Medicare beneficiaries do not take advantage of the annual open enrollment period. In the latest Medicare beneficiary survey, 71 percent of enrollees said they had not compared the plan they were enrolled in with other options available to them.
"People find the process overwhelming and frustrating," Neuman says. "There are often dozens of plans in their area and many people find it very difficult to make comparisons. I think people are aware there's an open enrollment period. They're inundated with marketing materials but may feel either ill-equipped to compare plans or find the process too hard and frustrating so they just throw up their hands" and stick with the coverage they have. But Neuman urges enrollees to take the time to review their coverage because it can pay off in their ability to get the care they need at a cost they can afford.
Tips for picking the right coverage
Neuman has some advice about how to proceed: Don’t just look at a plan’s premiums. That’s the easy part. And they aren’t the best gauge of what your total out-of-pocket costs will be during the year.
The best place to start to make your comparisons is the Centers for Medicare & Medicaid Services (CMS) plan-finder website. The medicare.gov home page will guide you through your enrollment journey. You can get detailed information about Part D choices. The site also includes a cost calculator. You can also chat live with a CMS representative or call the toll-free Medicare hotline, 800-MEDICARE (800-633-4227), 24 hours a day, seven days a week. West Virginia State Health Insurance Assistance Program — or WV SHIP— counselors are also available to help – (304) 558-3317 or toll-free (877) 987-3646.
Annual Deductible and Catastrophic Coverage
Each Part D Plan generally has premiums and other out-of-pocket costs, either flat copays for each medication or a percentage of the prescription costs. It also may have an annual deductible.
If your total drug costs — the amount you and your Part D insurance plan have paid — reach $4,430 in 2022, you will be responsible for 25 percent of the price of the rest of the prescription drugs you buy during the year.
If your drug costs continue to mount, you may reach the point of qualifying for catastrophic coverage. For 2022, once you have paid $7,050 for medicines — just what you paid, not including what your Part D insurance plan paid — you’ll be responsible for 5 percent of the cost for each of your drugs.
Be sure to check at medicare.gov whether the plan you’re considering has the medicines you take on its covered list, called a formulary. Those lists change from year to year, so it’s important to recheck your plan every year at open enrollment time.
This story is provided by AARP West Virginia. Visit the AARP West Virginia page for more news, events, and programs affecting retirement, health care, and more.
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