Hello again from Beth, one of your Pharmacy Chicks! Our article this week is for those who currently have Medicare insurance coverage or will be eligible for Medicare in the future. The annual open enrollment for 2022 Medicare drug plans begins on October 15th and runs through December 7th.
Open enrollment is the time to review your choices for the upcoming year to make sure you have the plan that is best for you and your current medical and prescription needs. There are options for Medicare Advantage plans and standalone prescription drug (Part D) plans. We will start by explaining these types of plans.
Medicare Advantage plans combine your medical and drug coverage into one insurance plan. These plans may often include other health coverages like dental, vision, and hearing. When you select one of these plans, it replaces your traditional Medicare Part A (hospital), Medicare Part B (medical), and Medicare supplement (Medigap) coverage. These plans also include prescription drug coverage. Generally, the Advantage plans have fixed copays for doctor’s visits to healthcare providers that are in the plan’s network. Before selecting one of these plans, you should make sure your preferred healthcare providers and facilities are in the plan’s network. The cost of these plans is your Part B premium from social security and may include an additional premium for medical and drug coverage that is paid to the plan.
Prescription drug (Part D) plans are standalone plans that work alongside your traditional Medicare Part A and Part B coverage. These plans have a monthly premium that is either paid directly to the insurance plan or can often be deducted from your Social Security check. When you have traditional Medicare and a prescription drug (Part D) plan, you may also have a Medigap supplement plan to cover the deductible and coinsurance on hospital and medical expenses.
Whether you decide on an Advantage plan or a standalone prescription drug plan you should review what the monthly premiums are and how plans cover (pay for) your medications. The best way to look at this is by using the Plan Finder on Medicare’s website (www.medicare.gov). Many pharmacies and volunteer groups will help their patients and members of the community find the plan that covers medications the best for the lowest cost. Every year plans change either their monthly premiums, medication copays, covered medications, or pharmacy participation. Every year this review should be conducted, even if you are happy with your current plan because plan coverages change each year.
Many Medicare enrollees in our community qualify for Extra Help with their medications. If you are eligible for Medicaid, QMB (Qualified Medicare Beneficiary), SSI, or the Medicare Low-Income Subsidy, you will automatically qualify for this Extra Help. The Social Security office can help you determine if you qualify for any of this assistance with either your copays or premiums. This Extra Help can reduce the copays for your prescriptions, eliminate your monthly drug plan premiums, reduce or eliminate your annual drug plan deductibles, and eliminate the coverage gap (donut hole). The prescription copays for those with Extra Help for 2022 will be $1.35 or $3.95 for generic/preferred drugs and $4.00 or $9.85 for other medications. These copays will be valid at any pharmacy that participates in the drug plan.
Another consideration when choosing a drug coverage plan is the pharmacy and pharmacist that you prefer to take care of your medication needs. Often the services provided by your pharmacist outweigh differences in your copays between pharmacies. The following services have been mentioned by my patients as items to consider when selecting your pharmacy of choice:
When you are reviewing your prescription drug plan choices for the new year, be sure to look at all your options and preferences before making your choice.
If you want help reviewing your Part D prescription drug plan, bring a list of your medications and your information by Sparta Drug Center. Regardless of what pharmacy you prefer, I will provide an unbiased review of your Part D drug plan choices for 2022 as I have in the community since the first open enrollment in late 2005. Payless Family Pharmacy also has employees that are trained in helping you make the best selection for you. There is also free counseling and assistance available through the Tennessee SHIP (State Health Insurance Assistance Program) at 1-877-801-0044.
Remember, you can always stop by and see one of the Pharmacy Chicks at Sparta Drug Center or Payless Family Pharmacy with any questions you have about any of our topics or other healthcare needs. Pharmacy Chicks out!
Comments
No comments on this item Please log in to comment by clicking here