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Failing to review your drug prescription plan during Medicare open enrollment could be a costly mistake

The Washington Post logo The Washington Post 10/22/2019 Michelle Singletary
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Charles Jones doesn’t mess around during Medicare’s open enrollment. He gets busy comparing his current coverage with any changes that may be in store for the next year.

The 69-year-old Pennsylvania resident, who has been retired since December 2015, has had three different Medicare Advantage plans from three different providers because he has moved a few times since retiring. Each moved required him to change plans. In 2020, he’ll be in yet another plan.

Why?

Drugs.

Jones will be in his fourth plan this time because of his required medication.

“In addition to checking their drugs to make sure they are still covered, Medicare recipients should check that the drugs they are taking haven’t been elevated to a new and more expensive tier,” Jones wrote. “That happened to me in 2019 and I had to change drugs.”

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And, it’s happening yet again, Jones said.

“Now this substitute drug is being raised in price for 2020,” he said.

It may be a pain to review your Medicare coverage, but failing to take the time to reexamine your prescription coverage could be a costly mistake if the medication you take is no longer part of your current plan. Please don’t assume what worked for you this year will serve you best next year.

Related video: Medicare enrollment season brings fierce competition among insurers to attract baby boomers (provided by CNBC)

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In addition to reviewing your prescription drug plan, Jones recommends checking that your physicians and hospitals are still part of your plan.

“I found out that my current plan dropped the local hospital as a provider so needless to say, I’m researching other plans,” he said.

Jones says he does his homework every year. This year, he’ll spend about 40 or 50 hours over a month comparing plan benefits.

You would be wise to take his advice during open enrollment for Medicare, which runs until Dec. 7.

Read: Medicare open enrollment starts Oct. 15. Do a checkup on your coverage.

Here are additional warnings from other readers about Medicare Part D, which covers prescription drugs.

— “One thing to be aware of when looking at Part D plans is that the same medication can be on a different tier, depending upon the particular plan.”

— “It’s Part D prescription coverage that has the greatest potential to broadside retirees with high and often unexpected drug costs. All Part D plans I’ve reviewed will hit you hard if you are prescribed name-brand tier 3, 4 or 5 drugs.” (Generally, a drug in a lower tier costs less than those in a higher tier.)

— “Long story short is that my wife and I will save $720 in 2020 on prescriptions. Folks you must read your ANOC (Annual Notice of Change).” 

Philip Moeller — author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” almost made a costly mistake a few years ago during open enrollment. He recounted his near slip-up to Sally Squires, a former Washington Post Health writer.

“He didn’t get a chance to check his Medicare Part D drug coverage plan until one day before Medicare open season ended,” she wrote. “He discovered that a key medication he needed had been dropped from his drug plan’s list of covered drugs.”

Moeller told Squires that it would have cost him $20,000 a year to buy the drug on his own. Fortunately, he was able to find another plan that covered the drug he needed.

To help you review your options, check out the redesigned Medicare Plan Finder on medicare.gov.

Moeller, who writes a blog for PBS NewsHour, took the updated tool on a test drive before open enrollment began.

Read: These tips can help you navigate Medicare’s updated online tool

One thing that surprises new Medicare enrollees is what it doesn’t cover, such as long-term care and most dental care.

Here’s a good tip from one reader: “When you get your Medicare card, take it to an office supply store and have it laminated in plastic else it will get dog-eared in a hurry as every doctor’s office will handle it and Xerox it. Don’t leave home without it.”

Health-care costs are no joke, so take the time to review your plan this year. You don’t want to make an expensive mistake because you procrastinated and didn’t check your coverage. 

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