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Medicare Part D Coverage Changing?

Numerous Prescription Bottles and CapsulesRecent regulation to have an effect on Medicare Part D coverage

More than 3 million Medicare beneficiaries will lose their Part D plan as a result of CMS regulation, according to Avalere Health, a private research firm.

The Centers for Medicare and Medicaid (CMS) has mandated that in order to simplify and eliminate confusion among Medicare Part D coverage, there must be meaningful difference between plans. Meaningful difference is measured by the plan members out-of-pocket cost share for plans offered by the same carrier.

As a result of this mandate, plan members may be switched into another of the carriers Part D plans. But an estimated 3 million plan members will not be switched and will lose their current coverage December 31st. If you are losing coverage, you will have a Special Enrollment Period (SEP) beginning October 1 through December 31 to enroll in a new Part D plan.

The mandate, although inconvenient for some, is actually a positive move by CMS. Too many Medicare beneficiaries voice concern that choosing between a company’s Part D plans is confusing.

It seems as if it is a game of smoke and mirrors in some cases. Plans with an annual deductible and lower co-pays, compared side by side with plans without a deductible, but with higher co-pays. Unless you have a crystal ball and know what medications you may require for the coming year, it is difficult to make a choice that will be in your best interests.

Steps to take if your Medicare Part D coverage is changing

If your carrier switches you to another one of their plans there are certain steps you need to take to make sure that the change is in your best interests.

  1. Check to make sure that your current medications are included in the formulary for the new plan. Not all Medicare Part D plans include the same listing of medications.
  2. Determine if your co-pays are going to change. Not all of carrier’s plans have the same co-pays for the plans tiers.
  3. Make sure you are able to use the same pharmacies. This is less of a concern because networks are usually company-based and not plan-based. But it’s good to eliminate any surprises.
  4. If you utilize a mail order pharmacy, make sure you will be able to continue to do so.

Compare plans online during the Annual Election period.


2 comments

  1. I want the costs for presciption cost on the United healthcare drug plans

  2. Ruth, Part D drug plans are offered on a State-By-State basis and plan costs can vary depending on where you live. Visit the Medicare website and choose Drug and Health Plans and then Compare Plans. You will be able to enter your zip code and even your drug and choice of pharmacies if you like to see all 2011 Part D plans that meet your criteria. Here is the link toUnited Health Care plans. They are branded as AARP MedicareRX Plans .
    David

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