Medicare Part D Open Enrollment

Medicare Part D Open Enrollment: What You Need to Know

If you’re 65 or older, make sure Medicare Open Enrollment is on your calendar. It is an important time of year to review your current medical coverage and healthcare needs — and select the most appropriate Medicare plan for the new year. Even if you’re already enrolled in Medicare, it’s still a good idea to review your plan, since coverage — and your health needs — may change from year to year. If you will become eligible for Medicare coverage for the first time in 2020, now is a good time to start learning about the different types of Medicare (i.e., Medicare Part A, Part B, Part C, and Part D), and what this means for you. The open enrollment period for Medicare 2020 begins on October 15, 2019 and ends on December 7, 2019. Here’s what you need to know about Medicare — especially Medicare Part D open enrollment.

What are the different types of Medicare?

Medicare is an insurance plan provided by the federal government and overseen by the Centers for Medicare and Medicaid Services (CMS). Medicare coverage is divided into four general sections, each of which covers different services. You must be enrolled in Parts A and B to be eligible for Part D.

Medicare Part A covers hospital expenses (i.e., pays for costs if you are hospitalized or placed in a nursing home). Medicare Part B covers outpatient services such as doctor’s visits, labs, immunizations, X-rays and surgeries that don’t require you to stay overnight in a hospital.

Medicare Part C — also known as Medicare Advantage — is a type of Medicare coverage offered by private insurance companies who contract with CMS. It is available to anyone who is enrolled in Medicare Parts A and B. Medicare Advantage plans cover not only the services provided by Parts A and B, but may also offer dental, vision and/or prescription drug coverage.

Medicare Part D is a supplemental form of Medicare that specifically covers prescription drug services. If you are enrolled in Parts A and B, then you can enroll in a Part D plan for prescription coverage.

Why would you want to get Medicare Part D?

Medicare Part A only covers medications that you receive while you are in a hospital or a skilled nursing facility. Medicare Part B only covers a limited number of medications — and typically only if they are administered in an outpatient setting (such as a doctor’s office or clinic). Examples include vaccines, injectable medications and medications given by IV.

This lack of regular prescription coverage can be a significant problem for older adults. According to a 2016 report published by the CDC, more than 90% of adults 65+ are taking at least one prescription drug each month — and more than 42% are taking five or more prescription drugs monthly. If you’re 65 or older, it’s worth looking into how signing up for Medicare Part D coverage may save you money — especially if you are already taking multiple prescriptions.

Who qualifies for Medicare Part D?
Anyone who is eligible for Medicare coverage is also eligible for Medicare Part D. In general, you will qualify for Medicare if you are 65 years of age or older. However, if you are under 65, you may also qualify under special circumstances — for example, if you’re disabled (and have been receiving disability checks from Social Security Disability Insurance for at least 24 months) or have end-stage renal disease.

Where can you sign up for it?
Once you are enrolled in Medicare Parts A and B, you can sign up for Medicare Part D coverage on the Medicare Plan Finder page. You can review and select health plans after entering your zip code and answering a series of questions. If you are already enrolled in a Medicare Part D plan, your plan will automatically renew, so technically, you’ll only need to visit the website if you want to change plans. However, it’s still a good idea to review your plan every year in case your current plan has changed — or to see if a different plan would better fit your current needs.

How much does it cost?

The Medicare Plan Finder page will also give you pricing information. You will be prompted to type in your list of medications and select your preferred pharmacy. The website will then populate with a list of plans you can choose from. The cost of your Medicare Part D plan may vary based on the plan you select and where you live. You’ll want to compare plan costs and copay to determine which plan will work best for you.

Follow These Steps to Choose the Best Medicare Part D Plan

2020 Medicare Part D Changes

Significant changes are coming to Medicare Part D in 2020. In the new year, you can expect increased drug savings and lower premiums, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

However, the biggest changes will be to Medicare Part D deductibles, out-of-pocket costs and copayments.

Here’s how the upcoming Medicare Part D changes will impact your wallet and healthcare coverage in 2020.

1. The initial deductible will increase by $20 to $435 in 2020.

This means you’ll pay slightly more before Medicare Part D begins paying its share. After the deductible is met, you pay 25 percent of covered costs up to the initial coverage limit.

2. The Initial Coverage Limit (ICL) will go up from $3,820 in 2019 to $4,020 in 2020.

This means you can purchase prescriptions worth $4,020 before entering what used to be known as the Medicare Part D Donut Hole, which had historically been a gap in coverage. However, what you pay for medications during the coverage gap has been decreasing each year and will reach 25% in 2020. This effectively closes the gap of past years.

3. The Medicare Part D total out-of-pocket threshold will bump up to $6,350 in 2020, a $1,250 increase from the previous year.

The True out-of-pocket (TrOOP) marks the point at which Medicare Part D Catastrophic Coverage begins. Under Catastrophic Coverage, you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

4. Catastrophic coverage copays will cost between $.20 to $.45 more.

Beneficiaries will pay $3.60 for generic drugs and $8.95 for brand-name drugs, up from $3.40 and $8.50, respectively. To understand more about Medicare Part D changes in 2020 and what they mean for you, talk to a pharmacist at your local Good Neighbor Pharmacy.