Can I switch my Part D drug plan if my medications change?
What are my options if I want to change my Medicare Part D plan to cover different medications?
If your current Medicare Part D plan no longer covers your medications, or if you’ve found a plan with better coverage for your prescriptions, you have several opportunities to change your plan. Here’s how you can switch to a plan that better suits your medication needs:
1. Annual Enrollment Period (AEP):
The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can:
Switch from one Medicare Part D plan to another.
Enroll in a Medicare Advantage plan that includes prescription drug coverage (if you want combined medical and prescription drug benefits).
Drop your Part D plan if you no longer need prescription drug coverage (though this may result in penalties if you re-enroll later without having creditable coverage).
Any changes you make during the AEP will take effect on January 1 of the following year.
2. Medicare Advantage Open Enrollment Period:
If you have a Medicare Advantage plan with prescription drug coverage, you can switch to a different Medicare Advantage plan or return to Original Medicare and enroll in a separate Part D plan during the Medicare Advantage Open Enrollment Period from January 1 to March 31.
This option allows you to make one change during this period, and the new plan will take effect the first of the month after your change is made.
3. Special Enrollment Period (SEP):
In certain situations, you may qualify for a Special Enrollment Period (SEP) to change your Medicare Part D plan outside of the regular enrollment periods. Some qualifying circumstances for an SEP include:
Moving to a new area where your current plan is not available.
Losing creditable prescription drug coverage from another source (such as employer-sponsored coverage).
Qualifying for Extra Help with prescription drug costs due to limited income and resources.
Entering, living in, or leaving a long-term care facility.
Your plan making significant changes, such as removing a medication from its formulary.
SEPs typically last for 2 months after the qualifying event.
4. Five-Star Special Enrollment Period:
From December 8 to November 30 each year, you can switch to a 5-star rated Medicare Part D plan if one is available in your area. You can use this special enrollment period once per year, even if it’s outside the regular AEP.
5. Review Plan Formularies:
When considering a change, review the formulary (the list of covered medications) for the new plan to make sure it covers the prescriptions you need. Each plan has its own formulary, and drugs are categorized into tiers with different costs. You can use Medicare’s Plan Finder Tool to compare plans and their formularies.
6. Check for Extra Help:
If you qualify for Extra Help, a program that assists people with limited income and resources to cover prescription drug costs, you may be able to change your Medicare Part D plan more frequently without penalties.
Key Takeaways:
You can change your Medicare Part D plan during the Annual Enrollment Period (Oct 15 to Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1 to Mar 31).
Special circumstances may qualify you for a Special Enrollment Period.
Always check the new plan’s formulary to ensure your medications are covered.
For personalized help with changing your Medicare Part D plan or finding the best option for your medications, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
