Medicare Part D Open Enrollment: What Your Patients Need to Know
For everyone 65 or older, it is an important time of year; Medicare Open Enrollment is in full swing. And as a pharmacist, a trusted healthcare professional in your community, you are keenly positioned to help patients understand their health insurance coverage.
Reminding eligible patients to review their current medical coverage and healthcare needs is critical. Because plans and healthcare needs can change from year to year, current Medicare participants must do an annual review to make sure they select the most appropriate plans for the new year. For patients who become eligible for Medicare coverage for the first time in 2021, it’s essential to educate them on the different types of Medicare (i.e., Medicare Part A, Part B, Part C and Part D) and how to choose the right plan.
Pharmacists are not allowed to recommend a particular plan to a patient, however pharmacists should provide useful guidance in interpreting the options, including plan costs, covered medications and out-of-pocket expenses.
The open enrollment period for Medicare 2021 will begin on October 15, 2020, and ends on December 7, 2020. Here's what everyone needs to know about Medicare, especially Medicare Part D open enrollment.
What are the different types of Medicare?
Patients who are newly eligible for Medicare or haven't been participating in anything but Part A may not understand the different types of Medicare. They may ask for guidance, to help them understand the terminology and their options. This simple breakdown can help get them started:
Medicare is an insurance plan provided by the federal government and overseen by the Centers for Medicare and Medicaid Services (CMS). Medicare coverage is divided into four general sections, each of which covers different services. Patients must be enrolled in Parts A and B to be eligible for Part D.
- Medicare Part A covers hospital and nursing home expenses.
- Medicare Part B covers outpatient services such as doctor's visits, labs, immunizations, X-rays and surgeries that don't require an overnight stay in a hospital.
- Medicare Part C (also known as Medicare Advantage) is a type of Medicare coverage offered by private insurance companies that contract with CMS. It is available to anyone who is enrolled in Medicare Parts A and B. Medicare Advantage plans cover not only the services provided by Parts A and B, but may also offer dental, vision and/or prescription drug coverage.
- Medicare Part D is a supplemental form of Medicare that specifically covers prescription drug services. Patients must be enrolled in Parts A and B in order to enroll in a Part D plan for prescription coverage
In general, U.S. citizens and legal permanent residents 65 years of age or older qualify for Medicare. However, under special circumstances, some people under age 65 may also qualify, such as people who are disabled (and have been receiving disability checks from Social Security Disability Insurance for at least 24 months) or people who have end-stage renal disease.1 Anyone who is eligible for Medicare coverage is also eligible for Medicare Part D.
Why is coverage important?
Medicare Part A only covers medications that patients receive while in a hospital or a skilled nursing facility. Medicare Part B only covers a limited number of medications—and typically only if they are administered in an outpatient setting (such as a doctor's office or clinic). Examples include vaccines, injectable medications and medications given by IV.
This lack of regular prescription coverage can be a significant problem for older adults. According to a 2016 report published by the CDC, more than 90% of adults 65+ are taking at least one prescription drug each month—and more than 42% are taking five or more prescription drugs monthly.2 Medicare Part D coverage could help eligible patients save money, especially if they are already taking multiple prescriptions.
How does a patient enroll?
Once patients are enrolled in Medicare Parts A and B, they can sign up for Medicare Part D coverage on the Medicare Plan Finder page. Eligible participants will be prompted to enter their zip code and answering the following series of questions:
- How do you get your Medicare coverage?
- Do you get help from Medicare or your state to pay your Medicare prescription drug costs?
- Would you like to add drugs?
The website will then populate with a list of plans to choose from.
For patients already enrolled in a Medicare Part D plan, their plan will automatically renew, so they will only need to visit the website if they want to change plans. Patients should be encouraged to review their plans every year in case their existing plan has changed or to see if a different plan would better fit their current needs.
What is the cost?
The Medicare Plan Finder page provides pricing information. The cost of a Medicare Part D plan varies based on which plan is selected and where the patient lives.
As a reliable healthcare professional, educator and a dependable member of your local community, now is a golden opportunity to encourage your patients to compare plan costs and copays. With your help, you can ensure your patients are able to determine which plan will work best for them.
- Digital Communications Division. (2015, August 21). Who is eligible for Medicare? Retrieved November 20, 2018, from https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html
- Centers for Disease Control and Prevention. Health, United States, 2016. May 2017. Accessed 1 October 2018. Available online at https://www.cdc.gov/nchs/data/hus/hus16.pdf#079
Delivering Care Beyond Prescriptions: A Marketplace Opportunity for Independent Pharmacies
The high-touch, high-quality, personalized care independent pharmacies provide creates a unique value proposition in a healthcare market where more chronically ill patients need accessible care. As payers are prioritizing improved patient outcomes and a reduction in overall healthcare costs, they need to also consider new reimbursement models for these pharmacy services, a framework under which independent pharmacies are uniquely positioned to excel.