Ask Ms. Medicare: Paying Attention to Open Enrollment for Part D

Q. I keep hearing that Part D’s “open enrollment” is important. What should I be doing during this period?

Open enrollment for Medicare’s prescription drug coverage starts Nov. 15 and ends at midnight on Dec. 31 every year. This is the time when anybody enrolled in a Medicare Part D drug plan—whether a “stand-alone” plan that provides only prescription drugs or a Medicare health plan that covers both medical and drug benefits—can switch to another plan for the following year. It’s also the time when people who have missed their original deadline for enrolling in Part D can join the program.

But there’s a good reason why it’s critical for Part D enrollees to pay close attention to open enrollment: The great majority of plans change their costs and benefits from one year to another. The coverage you get from your current plan on Dec. 31 may look very different on Jan. 1. So this is what you can do during open enrollment to avoid any nasty surprises in the new year:

• Look carefully at the “Annual Notice of Change” that you should receive from your current Part D plan no later than Oct. 31. Under Medicare rules, this notice must explain all coming changes. (If you haven’t received it by mid-November, call the plan immediately and ask for it.)

• Check whether any of your out-of-pocket expenses—monthly premiums, annual deductible and copayments for your prescriptions—will increase, and by how much. Note whether the plan’s design will change. For example, if it covers some drugs in the doughnut hole (the gap in coverage) this year, will it do so next year?

• Compare the details of your plan’s offerings for next year with those of other plans in your area. Bear in mind that it’s the specific drugs you take, including their dosage and how often you take them, that most determines what you’ll pay under any Part D plan next year.

• If you have Internet access, feeding those details into an interactive tool called the Prescription Drug Plan Finder on Medicare’s website will allow you to see whether your medications are covered and how much you’ll pay out of pocket under each plan in your area next year. (See AARP Bulletin Today’s guide on how to navigate the plan finder in the quickest way and avoid pitfalls.)

• If you can’t make this search yourself, call the Medicare help line at 1-800-633-4227 and ask a customer representative to search the plan finder for you to find your best deal, based on the drugs you use.

• If you need additional assistance to find a plan, call one of the help organizations listed here.

• Decide whether it would be worth your while to switch to another plan or not. But before taking any action:

• Remember that if you’re in a Medicare health plan that covers prescription drugs, you also need to compare how its medical benefits measure up to other plans. You can do this by going to Medicare’s website and clicking on “Medicare Health Plans—2009 Data” or by calling the Medicare help line.

• Make sure that changing to another plan will not affect any other medical or drug coverage you already have from outside of Medicare, such as from an employer or union plan. Check the possible consequences with your work-based plan’s benefits administrator.

• Check whether the new plan you’re considering imposes more restrictions on your drugs than the plan you have now. If it does, you may have to switch to an alternative medication or ask your doctor to support your request for an exception to the plan’s rules.

• If your current Part D plan has this year covered any of your drugs that are not normally on its formulary, or has waived a restriction on any of your drugs, check whether you can continue receiving these drugs or must apply for an exception to the plan’s rules for next year, too.

• To stay in your current plan, you do not need to do anything. Your enrollment will automatically continue next year.

• To switch plans, simply enroll in the new one of your choice, either online on Medicare’s website or by calling the plan. You don’t have to disenroll from your current plan. Medicare will automatically transfer you to the new plan, with coverage starting Jan. 1. But to ensure a smooth transition—so that your new coverage is logged into Medicare’s pharmacy computer system by Jan. 1—Medicare recommends enrolling in the new plan by mid-December.

Patricia Barry is a senior editor at the AARP Bulletin.