Shopping for a new Medicare prescription drug plan

| Kathryn Jones

Editor's note: This article first ran in 2016, but we've updated it in time for the 2018 Open Enrollment period.

When Anne Serpa of Asheville, North Carolina, first enrolled for her Medicare prescription drug plan (called Part D), she needed assistance from her daughter to navigate through the Medicare website.   

“I remember the process being confusing and wondering, ‘Why am I answering all these questions?’ and ‘What is the end result of this whole thing?’” she recalled.

In addition to living with psoriasis and psoriatic arthritis, Serpa has other health issues that require medications, which wind up making her feel like a “walking pharmaceutical company,” she joked. Biologics aren’t cheap, so finding an affordable drug plan was a priority. 

Serpa is one of 55 million people on Medicare – health insurance coverage for individuals who are 65 and older and those under 65 with permanent disabilities.

The Medicare Part D open enrollment period runs from Oct. 15 through Dec. 7. This is when people who have Medicare can change their prescription drug plan (PDPs) or enroll in a Medicare Advantage plan (a coverage option that includes traditional Medicare and prescription benefits).

So, which plan do I choose?

Determining which plan works best for you is a personal decision. Individuals living with psoriatic disease and other chronic illnesses have a lot to consider. 

If you’re already enrolled in Medicare, your provider network should send you something every September called an “Annual Notice of Coverage.” That’s your heads up to see whether your plan still works for you or if you need to start shopping around.

“Health needs can change in a year, so it is important for people with Medicare to use this time to check to see if they are getting the best price and best quality plan available,” said Andy Slavitt, former acting administrator for the Centers for Medicare & Medicaid Services (CMS). 

“Costs for Medicare Advantage and Prescription Drug Plans can vary by location. That’s why it’s important for people with Medicare to review their plan, shop and compare all their options.”

No matter what plan you choose, remember that the following things can change year to year:

  • Your monthly premium (the amount you pay each month)
  • Your annual deductible (the amount you must pay for services before your insurance company will cover the remaining costs)
  • Your copayments or coinsurance (ways that you pay for health care)
  • Drug availability

Each Medicare drug plan has a list of generic and brand-name prescription drugs that it covers known as a “formulary.” If a drug is not included in your formulary, a similar one should be available. 

However, if your doctor believes none of the drugs on your plan’s formulary will work for your condition, he or she can ask for an exception. That turned out to be the case for Serpa, whose doctor requested an exception for Simponi.

People living with psoriatic disease should compare their plan with other available plans every year in order to find better or less costly coverage for prescription drugs. This is especially important for those on biologics looking to cut down on those out-of-pocket expenses. 

If you decide to keep your current plan for 2018, then congratulations! You don’t have to do anything during open enrollment.

I’m still confused… now what?

If you’re having trouble navigating the Medicare website or simply don’t know where to start, you're in luck.

Request a free Health Insurance Quick Guide from NPF's Patient Navigation CenterThis guide outlines specific information to help you assess your health care needs for the upcoming year, compare Medicare plans and select the best one for your disease and treatment plan.

You can also hop aboard the Medicare SHIP, also known as the State Health Insurance Assistance Program (SHIP)

All 50 states, as well as the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands, have a SHIP that provides free assistance to Medicare beneficiaries and caregivers. NPF Patient Navigators can help you locate a SHIP program in your area, or you can locate your state’s SHIP by calling 1-800-MEDICARE. Give the operator your zip code and he or she will find a SHIP near you. Be sure to make an appointment as soon as possible because this is the busy season. Good luck!

Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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