Medicare Part D, also known as prescription drug plans, are optional, private insurance policies that help beneficiaries cover the cost of prescription medications.
You might need to switch Part D plans mid-year for various reasons, including changes in your healthcare needs or financial situation.
Switching Medicare Part D in the middle of the year is generally only possible if qualifying life events trigger a Special Enrollment Period (SEP).
In all other cases, changes can only be made during the Open Enrollment Period (AEP).
Understanding Part D Plan Changes Mid-Year
As mentioned above, switching Medicare Part D plans mid-year is only possible if you qualify for a Special Enrollment Period.
SEPs are triggered by several qualifying life events.
They include:
- Relocating or moving outside the service area of your current Part D plan.
- Losing creditable prescription drug coverage provided by an employer or union.
- Qualifying for programs like Medicaid or Extra Help, which are aimed at low-income individuals and families.
- Entering or leaving a nursing home or other long-term care facility.
Comparing Part D Plans for Cost and Coverage Benefits
Reviewing plan details is crucial before switching to a Part D plan.
There are three primary considerations involved in this:
- Premiums and Deductibles: These two factors determine the cost part of the equation. Compare plans based on premiums and deductibles to find one that optimally fits your healthcare needs and budget.
- Plan Formulary: A formulary is a list of covered drugs organized into different tiers based on cost sharing. It makes sense to switch Part D plans if your current prescription is no longer covered or moved to a higher-priced tier.
- Pharmacy Networks: Part D plan coverage is restricted to a limited network of pharmacies. Make sure your preferred pharmacies are included in your plan as going outside the network can affect out-of-pocket costs.
Here’s a breakdown of three Medicare prescription drug plans (PDPs) and their cost considerations.
| PDP Name | Monthly Premium | Annual Deductible | Copayments/Coinsurance |
|---|---|---|---|
| Wellcare Value Script | Varies by region ($0 in Atlanta, GA; $38 in Brooklyn, NY) | $590 | Tier 1 (Preferred Generic): $0 copay Tier 2 (Generic): $5 copay Tier 3 (Preferred Brand): 25% coinsurance Tier 4 (Non-Preferred Drug): 34%–45% coinsurance (varies by region) Tier 5 (Specialty Tier): 25% coinsurance |
| Humana Value Rx Plan | Varies by region ($16.50 in Atlanta, GA; $108.90 in Brooklyn, NY) | $573–$590 (varies by region) | Tier 1 (Preferred Generic): $0 copay Tier 2 (Generic): $0–$1 copay Tier 3 (Preferred Brand): 17%–23% coinsurance Tier 4 (Non-Preferred Drug): 35%–46% coinsurance Tier 5 (Specialty Tier): 25%–26% coinsurance |
| SilverScript Choice | Varies by region ($50.00 in Atlanta, GA; $56.90 in Brooklyn, NY) | $545 | Tier 1 (Preferred Generic): $2 copay Tier 2 (Generic): $7 copay Tier 3 (Preferred Brand): 16% coinsurance Tier 4 (Non-Preferred Drug): 40% coinsurance Tier 5 (Specialty Tier): 25% coinsurance |
Source: Collated from PDP plans offered by relevant private insurers.
Decision-Making Considerations for Changing Part D Plans
The ideal time to switch Part D plans is during the Medicare Open Enrollment Period, which runs from October 15 to December 7 of each year.
If your reason to switch plans is not urgent enough to trigger an SEP, you’ll need to wait for this window before making changes to your Medicare coverage.
A switch makes sense only under certain conditions, like new medications being too expensive for your budget on your current plan.
Compare prescription drug plans based on the tier in which they put the drugs you need. Higher tiers usually mean you’ll pay more in out-of-pocket costs.
You can also consult independent rating agencies like AM Best to evaluate specific Medicare Part D providers and plans.
How to Change Your Part D Plan
Here’s a step-by-step guide to changing Medicare prescription drug plans:
- Confirm your eligibility for a Special Enrollment Period by contacting the Medicare website.
- Compare Part D plans and providers using the Medicare Plan Finder Tool.
- Enroll in the new plan on time to avoid any lapse in coverage.
- Notify your current insurer about the change, if required.
CoverRight simplifies the process of switching Medicare Part D coverage by offering expert guidance on plan selection.
Get Help Navigating Medicare Changes Today
Getting the right Medicare coverage can be challenging, given the wide range of costs and coverage options to consider.
At CoverRight, our experts understand how comparing plans and aligning them with your unique healthcare needs and budgets can be overwhelming.
That is why they are focused on taking the guesswork out of Medicare choices and optimizing your coverage.
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