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Four Indications You Should Change Your Medicare Part D Coverage

Reasons to change your Medicare plan

If you had Medicare Part D coverage, you’re probably aware that you have options for the specific plan you purchase. If any of the following circumstances are applied to you, switching from your current plan to a different one may be worthwhile.

This is something you can do every year during the fall Open Enrollment Period. The OEP lasts from October 15 to December 7, 2021. And the Medicare Advantage open enrollment window runs from January to March.

1) The Formulary of Your Current Plan has Changed

All Part D insurance plans, including MA-PDs, have a formulary that categorizes medications into different tiers. Lower-tier drugs, which are usually generics, typically have low copays. Some may even be free of charge. However, the higher level of the medications you take, the higher your out-of-pocket costs will be.

The issue with plan formularies is that they can change from year to year. This means that the medicine that starts from a lower tier could be bumped up to a higher level in the future. As a result, your overall costs and insurance premiums will increase significantly. If this is the case with your current Part D coverage, it may be time to switch your plan.

2) Your Medication Requirements have Changed

It is always an excellent strategy to find a Medicare Part D plan that provides adequate coverage for the medications you use. However, if your prescriptions change, you must check whether a program can offer you a better deal.

For example:

Suppose you’re paying a significantly high premium for a specific health plan that puts one of your routine medications in a reasonably low tier. But then turn to a generic version of that drug that’s considerably cheaper; it pays to see whether or not you can get away with paying a lower premium.

Alternatively, if you have switched to another prescription in a higher tier under your current plan, it’s worth checking to see if another program has it at lower costs. 

If you’re registered in an MA-PD policy and considering changing plans during the Medicare Advantage Annual Enrollment Period. Then make sure to consult your current prescriptions. You should also think about Original Medicare plus a stand-alone Part D plan to see if that is the right option for your condition. 

[You have the choice to change your Advantage plan and enlist in Original Medicare and a Part D coverage during the January – March enrollment window, but note that you might not have access to the guaranteed-issue Medigap plan.]

3) Your Plan’s Network Pharmacies are Inconvenient

Medicare Part D programs, including MA-PD coverage, typically require applicants to fill their prescription medicines at in-network pharmacies. Depending on the situation, you might be required to pay the total cost for your medication if you use the offline pharmacy. If your current plan does not have at least one or two easily accessible pharmacies in-network that is reason enough to consider switching. This is true even if you have access to a mail-order service because waiting for prescriptions to arrive is not always an option.

4) You are Paying a High Premium Cost for a Medicare Part D Coverage that You Rarely Use

It’s sometimes worth paying more for a Part D plan that provides better coverage because lower copays offset what you pay in insurance premiums. However, you might better choose a lower-cost plan if you do not require any ongoing prescriptions.

Shop Around

Some people adhere to the same MA-PD plan for years and do well with it. But before you commit to your current coverage, do some research and weigh your options.

You can change your Part D coverage during Medicare’s annual open enrollment period, from October 15 to December 7. Suppose you cannot make adjustments during that period. In that case, Medicare Advantage open enrollment provides Medicare beneficiaries with the opportunity to change their coverage, including their drug. Note that the Medicare Advantage open enrollment period runs from January 1 to March 2022 every year.

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