Most people fill Medicare’s coverage gaps by buying a Medicare supplement (Medigap) plan and a Part D prescription-drug plan, or they get both medical and drug coverage from a private insurer with a Medicare Advantage plan.
Kiplinger’s recent article, “8 Steps to Picking the Right Medicare Plans During Open Enrollment” explains that you have from October 15 until December 7 each year to choose a Medicare Part D prescription-drug plan or a Medicare Advantage plan for the coming year. You can move from one Part D plan to another, or from one Medicare Advantage plan to another. You can also switch into a Medicare Advantage plan. However, if you have Medicare Advantage and want to switch to a Medigap plan plus a Part D plan, you may have limited Medigap options depending on your health. You can go with any Part D plan during open enrollment.
Things change, including the drugs you take or the doctors you see, along with the coverage under your plan for next year. A form should arrive at the end of September that indicates any changes for 2018 to the cost and coverage of your current plan. Look at changes to drug formularies, drug tiers, and co-pays that impact the drugs you take.
Remember that the Part D plan with the lowest premiums may not be the least expensive overall, if you have high co-pays for your drugs. The average Part D premium for 2018 will be $33.50 per month—that’s actually $1.20 less than 2017’s average. This is primarily because several large insurers are offering low-premium plans (sometimes less than $20 per month) with preferred pharmacies. Co-pays can differ, based on your drugs and the pharmacy you use.
If you’re looking for a Medicare Advantage plan, analyze the plans’ coverage and co-payments for the types of medical care you usually use. The average Medicare Advantage plan has a $30 premium per month in 2018, but some plans have $0 premiums because they may have some of the smallest provider networks and generally require higher co-payments for doctor’s visits, hospital stays, and other types of care.
Be sure that your healthcare professionals are included in the Medicare Advantage networks you’re evaluating and find out what happens if you use an out-of-network doctor. Some Medicare Advantage plans are PPOs. They just charge a higher co-payment and have a higher out-of-pocket maximum for out-of-network care. Most have provider networks in a state or region, but some allow you to use networks in other states.
Medicare Advantage may also offer coverage that traditional Medicare doesn’t, like vision and dental care or hearing aids.
Note that it’s becoming more common for Part D and Medicare Advantage plans to require prior authorization for high-cost medications. Many plans also require step therapy, where you try a less-expensive drug first, if possible.
If you end up deciding to keep your current plan, you don't need to do anything. You are automatically re-enrolled if the plan continues to be offered next year. Even so, review the Annual Notice of Changes.
Reference: Kiplinger (October 20, 2017) “8 Steps to Picking the Right Medicare Plans During Open Enrollment”