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Are your docs and drugs covered?

By Jennie L. Phipps · Bankrate.com
Monday, November 4, 2013
Posted: 4 pm ET

There's about a month left in Medicare's open enrollment, which runs through Dec. 7. If you haven't reviewed your current Medicare Part D or Medicare Advantage plan, now's the time.

Ignore all the hullabaloo over the Affordable Care Act's broken website. The Medicare site, Medicare.gov, is working just fine.

Sometime in October, you should have gotten an "Annual Notice of Change" in the mail that lists the changes in your Medicare Advantage or Part D prescription drug plan, including any increases in premiums and co-pays. It also compares the benefits you got in 2013 with what the benefits will include in 2014. Be sure to pay attention to the list of prescription drugs. HealthPocket.com, a technology company that compares health care plans, reports that in 2014, on average, Medicare Advantage plans will include 1,492 drugs on plan formularies and Part D Medicare prescription drug plans will offer 1,456. That's a lot of drugs, but it still pays to make sure that the ones you take are on the list. If your drug isn't on your insurer's formulary list, you'll have to pay its full cost, which could be a blow to your retirement planning budget.

HealthPocket also urges Medicare drug users to go one step further in analyzing their plans. Even if your drug is on the formulary, your plan can restrict access by limiting the quantity, requiring prior authorization or mandating a step therapy process that could require you to start by taking a less-costly drug until you prove that you really require the more expensive one to get better. Read the fine print to ensure that the drugs you take aren't restricted in this way.

It is also important to verify that the physicians and other medical professionals you use or might want to use are participating in your Medicare Advantage plan. If your network has been narrowed or your doctor has changed his mind, you might want to consider a switch. A Medicare supplement, or Medigap, plan is simpler -- any doctor who accepts Medicare is automatically on the list.

If you have questions and you are computer-savvy, go to Medicare.gov. If you feel more comfortable getting information the old-fashioned way, you can call 1-800-MEDICARE (800-633-4227).

Be prepared. Medicare is warning about long hold times. What else do you have to do in retirement but wait for this important information? It pays to be patient.

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12 Comments
Lola
November 05, 2013 at 1:46 pm

I have been given the 'hard sell' by the Medicare Advantage plans
in my area and all could and probably would end up costing me much more than the premiums for my Medicare supplement plan while limiting the Doctors and Hospitals I can use.

I can not see any advantage to the advantage plans.

Sue Nelson
November 05, 2013 at 1:24 pm

Must have some trolls on here. Anna, my Medicare D plan covers my inhalers. I pay 2 dollars co pay and if you are going through one a week they need to put you in the hospital, since each inhaler has about 200 doses.