The Roadmap for Medicare staff specialize in all topics related to Medicare Part D, choosing a Medicare plan, and making smart health decisions in retirement.
Those who switch often find a plan that lowers out-of-pocket costs. Will you be one of them?
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Open Enrollment is the time to choose a prescription drug plan that fits your current medication needs and budget. Even if you think your plan is working well for you, it’s always a good idea to make sure you’re getting the best value for your dollars.
To help, we’ve put together a list of the changes you’ll see in next year’s Part D plans. These changes, established by the agency that regulates Medicare (The Centers for Medicare & Medicaid Services, or CMS) will impact how and when you reach the four stages of coverage.
Need more information to understand the four stages of a Part D plan and how they work? Read this helpful article.
Deductible Stage: In 2020, you may need to pay more before your plan kicks in
The deductible is the amount you pay before your plan starts to share the cost of your medications. In 2020, the standard initial deductible will increase by $20 to $435.
As in previous years, you may also find Part D plans will offer deductibles that may be as low as $0. While these plans may be a good option for some, you should always make sure that the overall cost of the plan works well for you and your budget. More on the total cost of a Medicare Part D plan is available here.
Initial Coverage Stage: In 2020, your plan may cover more of the cost before you reach the “Donut Hole”
Once you meet the deductible amount set by your plan, you enter the Initial Coverage stage. In this stage, you will be responsible for a copayment (copay) or coinsurance. Your plan will cover the difference between what you pay and the retail price of the drug. How much you pay each time you fill your prescription depends on the drug tier in which your plan places the medication you are purchasing.
You and your plan will continue to share this cost until you and your plan have together paid an amount set by CMS every year. In 2020, that amount increased to $4,020, from $3,820 in 2019. Once this amount is met, you enter what’s known as the Coverage Gap, commonly referred to as the “Donut Hole.”
Coverage Gap Stage: In 2020, the “Donut Hole” will be harder to reach and easier to get out of
Once you enter this stage, you will need to pay more in out-of-pocket expenses. You will remain in this stage until your Total Out-Of-Pocket, also known as TrOOP, reaches $6,350.
In 2020, the Total Out-Of-Pocket cost was increased by 25%, to $6,350, from $5,100 in 2019. Want to know more about how to determine your TrOOP and how it will impact your budget? Read this helpful article.
To make it easier for people to afford their medications while in the Coverage Gap in 2020, CMS has required all plans to make available a discount for generic medications. Through this discount, your copay will never exceed 25% of the total cost of covered medications.
Coverage Gap Medication Discount Examples
- Brand-name medication: If your medication has a retail cost of $100, the drug manufacturer pays $70, you pay $25, and your plan pays $5.
- Out of the $100 cost, $95 will count towards meeting your TrOOP.
- Generic medication: If your medication costs $100, you will pay $25.
- Out of the $100 cost, the $25 you pay will count towards meeting your TrOOP.
Catastrophic Stage: In 2020, you will have a set minimum in your cost-sharing payments
Once you reach this stage, you will pay a minimal copayment or coinsurance for any generic medication or any brand-name drug.
In 2020, that amount is $3.60 for generic drugs or for brand drugs that are offered by two or more manufacturers that have a retail price lower than $72. If the price is higher, you will only pay 5% of the total cost. For other brand-name drugs, you will pay $8.95 if the retail price is under $179, and 5% of the cost for any medication that’s higher than that price.
Don’t forget to compare plans during Open Enrollment to choose the one that’s best for you!
If you are currently enrolled in a Part D plan, check your Annual Notice of Changes (ANOC). The ANOC, mailed to you by your current plan, will detail how these and other changes will impact your plan’s cost next year. With this information, you can determine if you are still in the plan that’s best for you.
Additionally, be sure to use the Medicare Part D Compare Plan Tool that is available here to help you gather and compare the coverage information from the plans offered in your area.
Don’t let Open Enrollment pass you by. Compare plans now to find the best one that best fits your needs and budget; this may save you money for next year!
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Opioids can be beneficial but be aware of the risks
Chronic pain from conditions such as arthritis and diabetes is common as we age, and opioids are often prescribed as the treatment. It’s also typical to have more surgical procedures as we get older, with opioids being the usual treatment for postsurgical pain. Therefore, it’s no surprise that each year an increasing amount of Medicare Part D members are prescribed an opioid.
While opioids can be very effective for managing pain, they can have side effects ranging from dizziness, nausea, and drowsiness to the risk of dependence and addiction. When opioids are used in older adults, seniors have an increased risk for falls and injury, as well as an increased risk for addiction. In fact, Medicare beneficiaries are now the fastest-growing population with diagnosed opioid use disorders. The higher the dosage or the longer you use opioids, the greater the odds are of your experiencing severe side effects and becoming dependent or addicted to the drug. As a result, the Centers for Medicare & Medicaid Services (CMS) now requires Part D plans to limit prescriptions to a maximum supply of 7 days for patients newly prescribed an opioid.
These additional tips can also help you use pain medication safely.
- When discussing potential pain treatment, ask your doctor if there are alternatives to opioids you can use. Let the doctor know if there’s any personal or family history of addiction. If the doctor recommends opioid treatment, ask if you can begin with the lowest dose possible.
- If you agree to try an opioid, it’s extremely important to use this medication exactly as directed by the doctor.
- Ask your doctor or pharmacist if you have any questions about the length of time you should take the medication, its side effects and how you should manage them.
- Don’t mix opioids with alcohol or sedatives such as sleeping pills or anti-anxiety drugs – doing so can be very dangerous to your health. In fact, more than one in five opioid deaths involves alcohol.
- Opioids can impair your driving so ask your doctor if it’s safe to get behind the wheel.
It’s also very important to keep opioids out of the hands of others since 55% of people who misuse opioids get them from family or friends.
- Don’t share your pain medication with anyone, even if the person has similar symptoms to your own.
- Store the medication in a secure place where it’s out of reach of children and out of sight to prevent accidental ingestion or theft.
- Search “opioid disposal” at FDA.gov to find out how to safely dispose of your unused medication.
If you know someone who is struggling with addiction, visit the National Drug Helpline website or contact the Substance Abuse and Mental Health Services Administration National Helpline
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Each year, many people experience an emergency related to severe weather, such as floods, hurricanes, tornadoes, snow or wildfires. For seniors who rely on daily medication to stay healthy, weather-related emergencies can pose even greater challenges. Lost or damaged medicine can present a life-threatening situation for people living in affected areas.
Here are seven tips to prepare for a severe weather emergency:
- Make a medication list: Keep an updated list of all your medications, including their strengths and dosages, and phone numbers for your doctors and pharmacies. Store the information on your smartphone and place a copy in a waterproof bag or container.
- Carry your healthcare cards: Keep your health insurance and prescription-drug benefit cards with you in a waterproof bag. That way, it will be easier to order new prescriptions if you lose access to your medication.
- Keep your medications together: Store medications in their original containers with the original labels and place prescription bottles in a waterproof bag or container.
- Prepare for special needs: If your medication requires refrigeration or electronic equipment, have a plan for temporary storage and administration.
- Order early: Reorder as soon as you are able, and consider ordering a 90-day supply of medication through your plan’s home delivery pharmacy to ensure a full stock.
- Have an emergency medicine kit: Stock a supply kit with any nonprescription medicines you may need, such as pain relievers, cold and allergy medicines, and antacids.
- Share your plan: Discuss your emergency medication plan with your pharmacist, doctor and family.
Plus, here are two important things to do AFTER a weather emergency occurs:
- Make sure your medication is safe to use. See if the appearance or smell has changed. Excessive moisture or heat can contaminate drugs. If you’re unsure about a drug’s safety, contact a local pharmacist or healthcare provider to discuss your concern.
- Stay on track with your dose. If you haven’t been able to take your medication, contact a pharmacist or doctor as soon as possible – even if you’re not experiencing any negative health effects. Do not take additional doses to make up for those you’ve missed, unless directed by your doctor to do so.
Being prepared for severe weather is vital for your safety and health. Follow these tips and make sure you have a plan for your prescription medications and for any assistance you might require in an emergency.
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Medicare Open Enrollment happens only once a year. This video helps you know where to turn to find the right Medicare Part D plan for you.
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Medicare Open Enrollment is here, and the clock is ticking towards making your final prescription drug (Part D) plan selection. Enrollment and taking time to understand your options can be stressful. This is particularly true if you are new to Medicare because the choices you make now may have a financial impact on your Medicare costs down the road.
Starting your research early to gather the information you need, compare plans and weigh your options can reduce the stress. If you need help navigating the complicated Part D terrain, don’t be afraid to reach out to those around. Here are a few tips for getting your research under way so you can choose next year’s Medicare Part D plan with confidence!
- Find reliable online tools. Medicare.gov offers detailed information about Part D plans and a tool to compare how drugs are covered by each provider. Signing up for Roadmap for Medicare newsletters will give you free access to our Roadmap eBook where you’ll find helpful checklists and a step-by-step guide to Medicare Part D.
- Check state and local resources. Consider contacting your State Health Insurance Assistance Program (SHIP). This program, which is funded by the federal government, has trained counselors in each state that can help you understand your Medicare plan choices and answer questions about switching plans at no cost to you. Check online for the phone number of the SHIP in your state or, if you are currently enrolled in Part D, you can easily find that contact information in your Evidence of Coverage. Look for local organizations hosting community events where you can get helpful tips and even have some fun! You can also make an appointment with a licensed Medicare insurance broker if you need additional help.
- Recruit family and friends. Once you’ve done your research, turning to a spouse, friend or relative can be helpful. They can assist by talking through your concerns, sharing additional online resources or pointing to events happening in your community. Since Medicare Part D Open Enrollment ends December 7, the Thanksgiving holiday can be a great time to wrap up your decision and choose the plan that’s best for you.
To learn more about how to maximize your network of friends and family and make the best use of resources to research next year’s Medicare plans, please watch this video.
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As you journey down the road towards choosing a Medicare prescription drug plan, you’ll likely hit some bumps along the way. Below are some tips to help you navigate the roadblocks and enroll in a Part D plan that best meets your needs.
Keep these do’s and don’ts in mind while considering your Part D options:
Don’t delay. It takes time to research and find the plan that best meets your needs. Make sure to start that research early to make sure you have enough time to identify and consider your options. Be sure to enroll before December 7th to avoid paying late enrollment penalty fees.
Do check a plan’s formulary (the list of drugs the plan covers) to make sure that all the prescription medications you currently take are covered. Also talk to your doctor about drugs that you may be prescribed in the coming year, so you can make sure that those are also on the formulary. While you can’t predict all your future prescription needs, it’s best to be well prepared for the ones that could be added to your treatment plan in the months ahead.
Don’t make your decision based solely on the plan’s monthly premium. The cost of the premium is only one factor to consider when determining the full cost of the plan. Deductibles and copayments also need to be considered, as well as the medications you take. If you regularly take only one or two prescription drugs, then a low premium plan may work well for you. However, if you take three or more medications, you may require more comprehensive coverage than a low premium plan offers. Remember to always evaluate the overall annual costs of the plan when making your selection.
Do opt for a plan with a preferred pharmacy network that includes your current retail pharmacy or another one that’s conveniently located. Preferred pharmacies offer lower copays for prescription drugs. If you’re on a medication that you take regularly for a chronic condition, you may be able to save even more money if there is a preferred mail delivery pharmacy option. It’s also easy and convenient to get your prescriptions delivered right to your home.
Don’t ignore Star Ratings. Plans are given between one and five stars by the Centers for Medicare & Medicaid Services (CMS) based on several factors including customer service and the quality of the care provided by the plan. Make sure to always check the plan’s Star Rating before you make your final decision.
Do seek out help in choosing a plan. Reading through each plan’s fine print and understanding what it all means is no easy task. Once you’ve done your research, take advantage of resources that are available to help guide you through the final decision-making process. Some of that help can be found right in your community. Your State Health Insurance Assistance Program (SHIP) provides a call line to answer Medicare questions. There are also Medicare insurance brokers that are available free of charge and can help you find the plan that meets your needs.
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Tips for enrolling in a Medicare Part D plan
Key Dates for Medicare Part D Annual Enrollment Period
Plan Information Available:
Note: The late enrollment penalty is 1% of the national average premium for every month you were without Part D prescription drug coverage or other creditable prescription drug coverage following your initial enrollment period, or if you had a break in creditable prescription drug coverage of 63 or more consecutive days. Creditable prescription drug coverage (for example, from an employer or union) means that it is expected to pay, on average, as much as Medicare’s standard prescription drug coverage. You will pay this late enrollment penalty for as long as you have Part D coverage.
Enrolling in a Medicare Part D prescription drug plan (PDP) is an important process that requires time and research, but it shouldn’t be a difficult one if you’re prepared well in advance for any potential bumps in the road. Unfortunately, nine in 10 people wait until the last minute to select a plan. (more…)
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