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Medicare Annual Enrollment FAQs OCT 15-DEC 7

Below are our frequently asked questions. For more information, please contact us for a consultation.

 

Q: What is Medicare’s Annual Enrollment Period (AEP)?
A: The Medicare Annual Enrollment Period, also known as the Annual Election Period, allows you the option to change your existing Medicare Part D prescription drug plan or Medicare Advantage plan for the following year, if desired. This occurs between October 15th and December 7th for plan changes effective January 1st. These plans are contracted annually, subject to change annually, or cancel. You may also join a drug plan at this time if you originally opted out (penalty may apply).
A: No. NO ACTION is needed on your Medicare Supplement. Rest easy knowing that they are NOT impacted by AEP. They are guaranteed renewable, benefits remain unchanged, with the added luxury to choose any provider who accepts Medicare.
A: The insurance company with whom you have your plan is required to mail you an Annual Notice of Change (ANOC) by October 15th announcing any plan changes for the upcoming year starting January 1st. Changes do occur annually so it’s very important to review!

If you haven’t received it by Oct. 15th, or misplaced it, call the customer service # on the back of your plan ID card and have them re-send it or access it through your online member account as it does contain important information you’ll want to review and keep in your files for reference during the new year.

When you receive your ANOC each year, it’s important to verify:

For Prescription Drug Plans

1. Are my routine medications still covered on the plan’s formulary?

2. What will they cost? (Based on assigned tier) What pharmacies provide the lowest costs?

3. How much is my monthly premium or annual deductible changing? Some plans waive the annual deductible on lower tier meds. This will be indicated in your ANOC.

For Medicare Advantage Plans, if drug coverage is included verify the same information above, plus…

1. Are my providers still in the network?

2. What are my deductibles/copays/coinsurances/cost-shares for all included plan benefits?

If the information is not clear in your ANOC, simply call your plan and ask a representative to verify these items for the upcoming plan year. If you’re satisfied with the plans’ updates, simply let the plan automatically renew. If you’re not satisfied, or simply curious to compare, starting October 15th, use our Medicare Rx plan shopping link below.

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You’ll be presented with companies I’ve chosen to represent, based on reputation, years of reliable experience and the added benefit that I can assist you during the year, if needed, for no added cost. Easily switch online during AEP if you choose. Your current Medicare Rx plan will automatically end when your new Medicare Rx plan begins (January 1st if during AEP). If you stay with your existing Rx plan, keep paying monthly premiums (if applicable), and the plan continues according to the new Annual Notice of Change (ANOC) mailed to you. Click here for optional Drug Plan comparison instructions:

View Instructions

If you still require assistance, call our office for assistance 614-899-0992.

A: No. Medicare Part D is optional. Yet if you don’t join when initially eligible or disenroll and decide to re-enroll in the future, you may have to pay a late enrollment penalty for the duration you maintain the Medicare Rx plan and you may have to wait for a valid enrollment period to sign up again.
A: Yes. Many people compare to see which avenue is less expensive for each of their medications. Even different pharmacies have different prices on the same medication whether through your drug plan or through a discount program. You can change your mind at any time how to pay for your meds (self-pay via a discount program vs. Medicare Rx plan). Also, keep in mind any medications you obtain through a discount or other external program are self-pay and will not be applied in any way toward your Medicare Rx plan deductibles, phases, or annual out of pocket amounts.
A: Most of the time the medication price may change if you moved into a different phase of Medicare’s drug benefit design. Call your drug plan or create account and log into your Rx plan’s online member account to see what phase you are in and if this affected the cost. The three phases as of 2025 are: Deductible Phase I, Copayment or Coinsurance Phase II, and Catastrophic Phase III. Please note, the Donut Hole/Gap phase is eliminated as of January 1st 2025.

Besides phase changes, there are a myriad of ever-changing factors influencing medication costs whether you get medications through a drug plan or elsewhere. These include which pharmacy you use, formulary changes, generic/brand availability, supply chain or ingredient issues, pharmaceutical company or pharmacy benefit manager decisions, competition, law changes and more.

A: First, consult with your prescribing doctor’s office. Share your concerns and drug plan formulary with them to find affordable solutions. Formularies are available on each plan’s website or within your online member portal, along with cost estimator tools. Ask about generics or alternatives. Some offices have advocates to help you apply for manufacturer’s or other’s programs. Explore self-pay, coupons or discount programs like Good Rx or Clever Rx https://cleverrx.com/WilliamPond (purchases made outside of Rx insurance plans will not apply to Rx plan deductibles, plan phases, or any out-of-pocket amounts!). Speak with a prescription assistance organization such as Prescription Bliss https://www.prescriptionbliss.com/ or if you have limited income and resources, see if you qualify for the federal Extra Help program. Apply online https://www.ssa.gov/medicare/part-d-extra-help or by calling Social Security at 1-800-772-1213.
A: The Medicare Prescription Payment Plan is a program created under the Inflation Reduction Act that requires Part D plans to provide their enrollees with the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy. The program begins January 1, 2025. Program participants will pay $0 to the pharmacy for covered Part D drugs, and Part D plans will then bill program participants monthly for any cost sharing they incur while in the program. Pharmacies will be paid in full by the Part D plans in accordance with Part D prompt payment requirements. If interested, you must contact your Part D plan for detailed information and to sign up.
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