Changing Part D Plans
Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone prescription drug plan (PDP) for those enrolled in Original Medicare or as a set of benefits included with the plan for those enrolled in Medicare Advantage.
You should make sure to find Part D coverage that meets your specific health care needs. Before you start looking at plans, make sure you know the prescriptions you take, including their dosages and usual costs and the pharmacies you regularly use.
When can I make changes to my Part D coverage?
Fall Open Enrollment runs from October 15 through December 7, with changes taking effect January 1. You can join a new Medicare Advantage Plan or stand-alone Part D plan (if you have Original Medicare) or switch between Medicare Advantage and Original Medicare (with or without a Part D plan).
The Medicare Advantage Open Enrollment Period (MA OEP) occurs every year from January 1 through March 31, and changes become effective the first of the following month. You can only use this enrollment period if you have a Medicare Advantage Plan. You can use the MA OEP to switch to another Medicare Advantage Plan or to Original Medicare, with or without a stand-alone prescription drug plan.
If you have Extra Help, the federal program that helps pay your out-of-pocket costs for Medicare prescription drug coverage, you can make changes more often. You have Special Enrollment Periods (SEPs) that allow you to enroll in or switch Part D plans once per quarter in the first three quarters of the year.
You may qualify for another Special Enrollment Period. SEPs allow you to change your health and/or drug coverage outside normal enrollment periods. For example, if you move out of your plan’s service area, you would receive an SEP to switch to another plan.
What should I consider when choosing new Part D coverage?
There are many things to consider before choosing a plan, depending on your needs, your financial situation, and your preferences. Some of the following guidelines may be more important to you than others.
- Coverage: First ensure that a plan has your drugs on its formulary. You should also find out if there any restrictions on your covered drugs, such as prior authorization, step therapy, or quantity limits.
- Costs: Medicare’s Plan Finder tool provides a yearly estimate of out-of-pocket costs for each plan you are comparing. You may owe a premium, deductible, and copays.
- Network: You may pay less for your drugs at preferred and in-network pharmacies. If you go to a pharmacy that’s close to your home or easy to get to, it may be beneficial to look for a plan that categorizes that pharmacy as a preferred in-network pharmacy.
- Star rating: Medicare uses a star rating system to measure how well plans perform in different categories. Medicare’s Plan Finder tool includes plans’ star ratings.
New in 2023! It may be helpful for you to know that, starting in 2023, all Part D plans will cover vaccines with no cost to you and will cap your monthly insulin cost at $35.