If you have prescription drug coverage with Medicare, then you either have a Medicare Advantage plan that covers prescriptions (also known as MA-PD plans) or a standalone Part D drug plan (also called PDPs). Either way, you bought the plan from a private company since Original Medicare doesn’t cover prescriptions. And because these plans are sold individually on the private market, that means there’s competition.
Translation? You have options when it comes to getting your medications covered under Part D.
Maybe you’re happy with your plan but the costs are getting too high, or maybe you’re not as thrilled with the coverage as you thought you’d be when you first enrolled.
In any case, you’ve got a couple of options for changing your Part D coverage, the best time being during Open Enrollment in the fall.
Let’s talk about when and how to switch your Part D coverage.
When to Make Changes to Part D
There are only certain times during the year when you can make changes to your Medicare coverage. This is true for all parts of Medicare, including Part D. But unlike with other parts, Part D has fewer options for making changes during the year.
If you already have a drug plan, you can use one of the following enrollment periods to switch your coverage:
- Medicare Open Enrollment. This enrollment period runs from October 15th through December 7th each year. You can use it to make as many changes to your coverage as you need until the deadline. Any changes you make take effect on January 1st. If you have Part D (whether through a Medicare Advantage plan with drug coverage or a standalone policy), you can use the OEP to switch plans or drop Part D coverage altogether. This is the best time to compare Part D options in your area and make sure you’ve got what you need in place for the next year.
- 5-Star Special Enrollment Period. The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, rates private Medicare plans each year on a scale of 1 to 5, with 5 being the highest score. They do this for Medicare Advantage and standalone Part D drug plans. If there’s a 5-star plan in your area, you can use a 5-star special enrollment period one time between December 8th and November 30th to enroll in that 5-star plan. (And yes, that date range is correct.)
- Medicare Advantage Open Enrollment Period. If you have Medicare Advantage, you can use the annual Medicare Advantage Open Enrollment Period (January 1st through March 31st) to make a one-time change to your coverage. This means changing MA plans or going back to Original Medicare. And if you do go back to Original Medicare, you can also join a Part D drug plan during this time. But this is a one-time change, unlike the open enrollment period in the fall, and it’s only for people with a current Medicare Advantage plan.
These are the main ways you can switch your Part D coverage. But because life is complex, Medicare offers enrollees additional chances to make changes when certain things happen. You may qualify for a special enrollment period to switch, add or drop coverage based on:
- Losing your current coverage
- Being eligible for other drug coverage
- Plan changes for your current plan
- Other special situations
There are actually quite a few scenarios that might qualify you for a special enrollment period. Maybe you’ve moved outside of your current plan’s service area, you now qualify for TRICARE, your current plan isn’t contracting with Medicare anymore, or you got some misleading info from someone helping you pick a drug plan (like a federal employee) and now need to make a change.
If you think you qualify for a special enrollment period, contact Medicare directly. They can help you figure out your situation and the time period you have to apply for new coverage.
How to Switch to a New Part D Plan
When you’re ready to switch to a new Part D drug plan, you enroll the same way you enrolled in Part D for the first time. Options include:
- Using the Medicare.gov Plan Finder
- Calling Medicare directly
- Using a private marketplace, like this one (MedicareEnrollment.com)
- Enrolling directly through a specific insurance company
We recommend comparing your options carefully against what you have already. Once you’ve found the plan you want, use one of the above methods to enroll. There’s no need to worry about canceling your current Part D plan, either. That happens automatically once your new coverage starts.
Your new plan will start on January 1st if you enrolled during open enrollment. If you enrolled during any other period, you’ll need to check with the plan to see when it takes effect.
A word of caution: don’t drop your Part D coverage without a backup plan in place. If you go more than 63 days in a row without “creditable drug coverage” (what Medicare considers to be comparable to its own prescription drug coverage under Part D), you may have a penalty for enrolling in Part D later.
Things to Keep in Mind When Switching
Of course, before you make any changes to your current Part D coverage, you need to figure out why it’s not working (if it’s not) and what kind of changes you need to make. That’s easier said than done. Even if you know what the problem is — too high a premium, for example — it can be tough to wade through all the options on the open Part D market to find something better.
If open enrollment is happening or it’s just around the corner, take a look at your Annual Notice of Change (ANOC) first. This is an official notice that your drug plan is required to send you in the fall, ahead of open enrollment. It should list out any plan changes for the coming year. Knowing how your plan is going to change will give you a starting point for knowing what to look for as you compare new Part D plans.
In particular, pay attention to:
- The monthly premium. Part D premiums vary widely. You might pay as little as $7 a month, but the average in 2022 is about $33 according to CMS. When we looked at CMS state data for next year, we found that nearly everyone with Part D (99.8%) will have access to a Part D plan that costs less than the one they had in 2021. The same was true between 2020 and 2021. Point being, premiums for Part D trend down, so take a look at your current premium and see if there’s something even more affordable for next year.
- Cost sharing amounts. The premium isn’t the only cost to consider, though. Your Part D deductible and how much you pay out of pocket at the pharmacy counter also matter. Compare your deductible (if you have one) against new options that might have a lower one, or none at all. Then take a look at what your copayments or coinsurance rates are for the drugs you take.
- The drug formulary, especially the tiers. And while you’re adding up the cost of your medication, go ahead and compare your current plan’s drug formulary to other options in your area. Cost alone shouldn’t determine the Part D plan you get because there’s no point in paying less for a plan that doesn’t cover the medications you need. Cash prices might actually work out better for some low-cost generics. But over time, you might need pricier medications or specialty drugs, and insurance is going to help with those. At the very least, make sure any plan you get covers the specific drugs you need right now.
- Covered pharmacies. Some drug plans might have network restrictions or preferred pharmacies that they want you to use. Check the plan’s network, if it has one, and/or list of preferred pharmacies to see if it includes the places you like to go. If you have a specific pharmacy you like, make sure your current Part D plan covers it. If it doesn’t, find a plan that does.
Switching your Part D plan requires some legwork, but it doesn’t have to be a solo project. Get your spouse or a friend involved, or call in the professionals. You can use the Medicare.gov Plan Finder to find private drug plans each year.
Or if you need help comparing options with the help of a human, you can call us at 1-800-485-6202 to speak with a licensed agent about what’s available in your area. You’ve got options when it comes to Part D. Make sure you’ve got the right coverage in place when you need it.