If you have a Medicare Part D prescription drug plan, it can be easy to assume that once you find a plan that works, you can simply keep it year after year.
You can. But that doesn’t necessarily mean the plan will stay the same.
Medicare Part D plans can change their costs, covered medications, pharmacy networks, and coverage rules from one year to the next. Your prescriptions can change, too. That’s why reviewing your Part D coverage every year is an important part of managing your Medicare coverage.
Here are some of the most important changes to watch for.
1. Your Monthly Premium Can Change
Your Part D plan’s monthly premium can increase or decrease from one year to the next.
A plan that was competitively priced this year may not be your lowest-cost option next year. But premium alone doesn’t tell you whether a plan is a good fit.
Your total prescription costs matter more than simply finding the plan with the lowest monthly premium.
2. Your Deductible Can Change
Part D plans may have an annual deductible.
The amount can change from year to year, subject to Medicare’s rules and limits. Plans may also apply their deductible differently depending on the medications you take.
That means it’s important to look beyond the premium and understand how the deductible affects your specific prescriptions.
3. Your Plan’s Drug List Can Change
Every Part D plan has a list of covered medications called a formulary.
That formulary can change.
For example, a medication you take could:
- Move to a different drug tier
- Be replaced by a generic or alternative medication
- Become subject to additional coverage requirements
- In some circumstances, no longer be included on the formulary
This is one of the biggest reasons I recommend reviewing your Part D plan every year.
A plan that covers all of your medications well this year may not necessarily do so next year.
4. Your Drug’s Tier Can Change
Part D plans typically divide covered medications into different pricing tiers.
For example, a plan might have tiers for preferred generic, generic, preferred brand-name, non-preferred, and specialty medications.
If one of your prescriptions moves from a preferred tier to a non-preferred tier, your cost could increase substantially even though the medication is still covered.
5. Copayments and Coinsurance Can Change
The amount you pay when you fill a prescription can also change.
Depending on the plan and medication, you might pay:
- A fixed copayment, such as $5 or $20
- A percentage of the medication’s cost, called coinsurance
Those amounts can change from year to year.
This is another reason comparing premiums alone can be misleading. A plan with a slightly higher premium could potentially have lower overall costs for your particular medications.
6. Pharmacy Networks Can Change
Your Part D plan may have agreements with certain pharmacies.
Some plans also distinguish between preferred and standard network pharmacies. You may pay less when using a preferred pharmacy.
Those arrangements can change.
A pharmacy that gives you preferred pricing this year might not have the same status next year. In some cases, a pharmacy may no longer participate in the plan’s network at all.
If you have a pharmacy you prefer to use, check its network status when reviewing your coverage.
7. Coverage Rules Can Change
Part D plans can use certain rules to manage prescription drug coverage.
These can include:
Prior authorization: The plan may require approval before covering a medication.
Step therapy: You may need to try another medication before the plan covers a particular drug.
Quantity limits: The plan may limit how much medication it will cover during a specific period.
Changes to these rules can affect how easily you can obtain a prescription even when the medication remains on the plan’s formulary.
How Will You Know What’s Changing?
Each fall, your Medicare plan sends you an Annual Notice of Change (ANOC).
Don’t automatically put this document aside.
The ANOC explains changes to your plan’s coverage and costs that will take effect January 1.
When you receive it, pay particular attention to changes involving:
- Monthly premiums
- Deductibles
- Your medications
- Drug tiers
- Copayments and coinsurance
- Pharmacy networks
- Prior authorization and other coverage requirements
Your ANOC is one of the most important Medicare documents you’ll receive during the year.
Why an Annual Part D Review Matters
The question isn’t simply:
“Is my current Part D plan still available?”
A better question is:
“Is my current Part D plan still a good fit for the medications I take and the pharmacies I use?”
Those are very different questions.
Even if you’re happy with your current plan, reviewing your coverage each year can help identify changes before they become expensive surprises in January.
Medicare Annual Enrollment Period
Medicare’s Annual Enrollment Period runs from October 15 through December 7 each year.
During this period, Medicare beneficiaries generally have an opportunity to review their prescription drug coverage and make changes for the following year.
New coverage selected during the Annual Enrollment Period generally begins January 1.
Minnesota Medicare Help — Without the Pressure
Medicare Part D can be confusing because there isn’t one plan that’s automatically best for everyone.
The right choice depends on factors such as:
- The prescriptions you take
- Dosages and quantities
- The pharmacies you use
- Plan premiums and deductibles
- Copayments and coinsurance
- Formulary and coverage requirements
Visit Contact Us to schedule a personalized Medicare review and get answers tailored to your situation.
For official Medicare information, visit the Medicare.gov website.
YourMedicareMN is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability and benefits vary by location and plan. Contact the plan or Medicare for complete plan information.
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