Medicare Part D: Things People With Cancer May Want to Know

+ -Text Size

TOPICS

Switching drug plans in the future

Each year, you will be able to choose a new drug plan during the annual open enrollment period, which is between October 15 and December 7. Any changes then go into effect on January 1st of the following year. (January 1 is when your new plan starts if you chose to switch, or when your current plan takes effect for the next year.) Once they’ve started with the plan on January 1st, most people won’t be able to switch plans until the next open enrollment period.

Note: If you are eligible for Medicaid, you can switch plans monthly rather than yearly. And if you are eligible for the special low-income assistance through the Medicare Part D program, you can switch plans up to twice a year – once during the open enrollment period and once in between enrollment periods.

Even if you are satisfied with your current drug plan, there are many reasons you might want to switch plans:

Your drug needs may change or your plan’s coverage may change

In the course of a year, your prescription drug needs may change. For instance, your cancer treatment may end or your doctor may change your treatment. During the year, you also might be prescribed drugs for other health problems that aren’t related to your cancer treatment – such as medicine to treat high blood pressure. You may find that your current drug plan isn’t the best option for your new drug needs. Your drug plan may also change its coverage rules or formulary in a way that affects your drug coverage or your out-of-pocket costs.

As the end of the year nears, if you do nothing during the open enrollment period you will automatically be re-enrolled with the same company you were with the past year. But the plan may not be the same next year – drugs, deductibles, and premiums may change. Find out if the plan will still meet your needs before you allow yourself to be automatically re-enrolled.

If your drug needs have changed, and you find that your plan doesn’t cover your new medicines, you may decide to switch drug plans. Or, if you learn that another plan in your area offers lower prices for your new drugs (while also covering the other medicines you take), you may want to switch plans. If you decide to switch, you will need to review your options, decide on a new plan, and figure out when you can make the change. (See the section called “Making a Part D plan decision” for details on when you can change plans.)

Your income may change

If your income has gone down in the course of the year, you may be able to get Extra Help, the special low-income assistance provided through the Medicare Part D program. This program helps you pay your monthly premium, and gives you a lower yearly deductible and lower drug co-pays.

Medicare beneficiaries who are eligible for Extra Help must choose a plan with a premium that is covered by Extra Help. If you qualify but your current plan has a premium that is higher than the Extra Help coverage, then you must either switch plans or pay the difference in cost yourself. See the “How much will the Part D drug plan cost?” section to learn more about getting help with your Part D costs.

Your plan may leave the Medicare program

The Medicare drug benefit uses private plans to deliver benefits instead of a single government-based plan. These private plans can decide to join or leave the Medicare program at any time. They also may change their benefits or drug formularies. New managed care options in the Medicare Advantage program may also join or leave the program. For these reasons, the drug plan options in your area may change from year to year.

If a plan withdraws from Part D, enrollees must be notified at least 60 days before the plan’s withdrawal. This notice includes a written description of other options within your service area. Enrollees then have to choose another plan under special enrollment – they don’t have to wait until the next open enrollment period to switch plans.

Other factors that might make you want to change drug plans

Other factors may also affect your decision to stick with your current drug plan or switch to a new one. For example, the tools used to help people decide on a drug plan and other information to help beneficiaries may get better over time. In this case, you might find out later that a different plan would actually meet your needs better than the one you have now. If you are happy with your current plan, there might not be a need to change or even look at a different plan.

But the drug benefit is set up so that it that encourages Medicare beneficiaries to shop around – just as you would for groceries or a new car – and find the best value. So it might not hurt to compare plans each year when you have the chance to change, even if you’re OK with your current plan.


Last Medical Review: 01/22/2014
Last Revised: 01/23/2014