NDSU Extension - Mercer County


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Why annual Medicare prescription drug plan comparisons are important

Medicare prescription drug plans, Medicare Part D, SHIC (Senior Health Insurance Counseling)

Submitted by Dena Kemmet, Extension Agent/Family and Consumer Sciences

Should you compare your Medicare Prescription Drug Plan, also known as Medicare Part D, during the open enrollment period every year? While there are no requirements to compare or change plans every year, there are certainly some benefits to consider.

The prescription drug plans offered by insurance companies are approved by Medicare every calendar year, so plans change from year to year. For example, in 2010, there were 46 plans available. In 2011, that number dropped to 33 and remained the same for 2012 and 2013. Last year there were 26.

As a result, the company you have a plan with this year may not offer plans next year. Unless you act, you could end up without coverage for 2017.

If the company you enrolled in for your 2016 prescription drug plan offers plans in 2017, but not specifically the same plan, you may simply be rolled over into one of its other plans. This change could be costly!

Each year a variety of things can be changed in the plans that may affect out of pocket costs:

  • Monthly premium amounts.  Medicare has informed us the average premium is remaining relatively flat this year.
  • A higher deductible. The maximum allowed deductible for 2017 is going up to $400. Last year more than half of the plans had the highest allowed deductibles.

The greatest factor in determining out-of-pocket expense are changes to the plan’s 2017 formulary (list of covered medications). Medications covered in 2016 may not be covered in 2017; this will result in you paying full price. The company may also change the tier levels for each of your medications. Medications that were assigned as Tier 1 in 2016 (the lowest price generics) can be changed to Tier 2 or 3; which increases the cost you pay at the pharmacy.

If you participate in the open enrollment period for Part D, you will have the opportunity to select a plan that is best for you and your unique situation. These plans are very different for each individual based on current medications and pharmacies used.

The only cost to participate in open enrollment is your time. You can get a comparison in several ways. Meet with a local Senior Health Insurance Counselor (SHIC). Attend one of the Insurance Department’s free annual enrollment events. Call 2-1-1 and submit information over the phone. You may also call the Department’s State Health Insurance Counseling (SHIC) program toll-free number, 888-575-6611 or go online and enter your information at www.medicare.gov. Make sure you have the following available for whichever method you choose:

  • An up-to-date list of your current medications that includes the name of the medication, the dosage and the number of times it is taken each day.
  • Your Medicare card.

Annual enrollment period is October 15 through December 7. All plan coverage begins January 1, 2017.

For additional information, contact your local Senior Health Insurance Counselor, Dena Kemmet, at 873-5195.

Source: David Zimmerman, Director, Consumer Assistance Division, ND Insurance Department


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