Some Medicare beneficiaries will lose their stand-alone drug coverage December 31 due to their Part D plan not renewing. Millions more will lose their Part D coverage because their Medicare Advantage plan is not renewing.
Although getting notice in the mail that your drug coverage will not be renewed can be frustrating it’s no reason to panic.
If your Part D or Medicare Advantage plan is not renewing you are entitled to a Special Enrollment Period to find another suitable plan.
Why are some Part D plans not renewing?
There can be several reasons why a Part D plan doesn’t renew for the following year. One reason has to do with regulation regarding Medicare Part D plans. CMS has mandated that there must be meaningful difference between a carrier’s Part D plans.
Meaningful difference is measured by the members out-of-pocket cost when using the plan. Many carriers offered plans that looked different on the surface but the member’s out-of-pocket cost would be nearly identical for each of the plans.
For instance one plan may include an annual deductible but have lower co-pays while another plan had no deductible but higher co-pays. In all fairness this was a positive move by CMS to give Medicare beneficiaries a real difference and choice between a carrier’s plans.
Many people are losing their Part D coverage because it is included in a Medicare Advantage plan that is not renewing for next year. These members will also be entitled to a Special Enrollment Period beginning October 1st through January 31st.
Steps to take if your Part D is not renewing
If you plan is not renewing your current insurance company may want to switch you to another of their plans. Even if you have an option to stay with the same company you owe it to yourself to compare Part D drug plans. Here are points to consider:
- The monthly premium is not the only factor but if it’s not affordable you need to look somewhere else.
- Even if you have an option to stay with the same company make sure your medications are included in the plan’s formulary. Not all plans include the same drugs.
- Make certain that you will be able to use your preferred pharmacy and also check to see if your mail order pharmacy benefit is acceptable.
- Determine which tier your medications will be listed in. Just because you have a drug in tier 2 doesn’t mean that all plans will include it in tier 2.
- Carefully look at the co-pays to determine your projected out-of-pocket cost.
Don’t get hooked into believing that just because a Part D plan has a low premium it is the least expensive. It’s not about the up front cost but rather your projected out-of-pocket cost throughout the year.
If your Part D plan is not renewing for don’t panic. You are entitled to a Special Enrollment Period and you can compare Part D online.