Medicare beneficiaries will have an opportunity to take a closer look at their health and prescription drug coverage when Medicare’s annual Open Enrollment period begins Oct. 15.
The enrollment period runs through Dec. 7 and allows individuals with Medicare to review their current coverage and make changes for the upcoming year. Changes made during the enrollment period will take effect Jan. 1.
While it may be tempting to simply keep the same plan from one year to the next, Tyler Staten, a pharmacist at Gannaway Drug Store in Warren and owner of InsuredRx Agency, encourages Medicare beneficiaries to take time each year to review their prescription coverage.
Staten is both a pharmacist and an insurance agent, giving him a unique perspective when helping customers understand how their prescription medications and insurance coverage work together.
“Medicare plans can change from year to year, and so can a person’s medications,” Staten said. “Just because a plan worked well for you this year doesn’t necessarily mean it will be the best plan for you next year.”
Medicare health and prescription drug plans can change their costs, covered drugs, pharmacy networks and other benefits each year. It is recommended that beneficiaries review information from their current plans, including the Annual Notice of Change, to determine whether their coverage will continue to meet their needs.
For prescription drug coverage, one of the most important things to examine is the plan’s formulary — the list of medications the plan covers. Plans can place medications in different cost tiers, meaning the amount a beneficiary pays for a prescription can vary from one plan to another.
“It’s not just about what the monthly premium is,” Staten said. “You have to look at the whole picture — the medications you take, what those medications cost under the plan, the deductible, the pharmacy you use and whether that pharmacy is preferred or in network.”
Pharmacy networks can also make a difference in out-of-pocket costs. Prescription plans have preferred in-network pharmacies where beneficiaries may pay less for covered prescriptions.
Staten said reviewing coverage is particularly important for individuals whose medications have changed during the year.
“If you started a new medication, stopped taking something, changed medications or had a medication move to a different tier, that can change the best plan for you,” he said. “That’s why I tell people not to assume their current plan is automatically their best option.”
Beneficiaries also should consider whether their current plan is still being offered and whether its costs or benefits will change in the coming year. Those who are satisfied with their current coverage and find that it continues to meet their needs do not necessarily have to make a change.
However, doing nothing should be an informed decision rather than simply allowing a plan to renew without reviewing it.
“You don’t have to change plans just because it’s Open Enrollment,” Staten said. “But you should know what you’re getting for your money before you decide to stay where you are.”
For Medicare beneficiaries who would like assistance reviewing their options, Staten is available at Gannaway Drug Store by appointment.
Those interested in scheduling an appointment can contact Gannaway Drug Store at 870-226-3751 or visit the pharmacy at 101 N. Main St. in Warren. They may also call InsuredRx at 870-412-1200 to schedule a review.
Staten encourages individuals to bring a current list of their prescription medications, including dosages, to their appointment.
“The more accurate information we have about the medications you take, the better we can compare your options,” Staten said. “The goal isn’t to put someone in a different plan just for the sake of changing. The goal is to find the coverage that makes the most sense for that individual.”
Medicare beneficiaries can also review plans through Medicare’s official Plan Compare tool online or by calling 1-800-MEDICARE.
Open Enrollment ends Dec. 7, making the coming weeks an important time for Medicare beneficiaries to review their coverage rather than waiting until the deadline approaches.
“Take the time to look at your plan,” Staten said. “A little time spent reviewing your coverage now could save you money and prevent surprises at the pharmacy next year.”
