Has Your Prescription Drug Coverage Changed? What to Check During Medicare AEP

Posted by Rolando Arellano, J.D.
Estimated Reading Time 1 minute 42 seconds

If you take prescription medications, reviewing your drug coverage should be an important part of your Medicare Annual Election Period (AEP) checklist. A plan that worked well for you this year may not necessarily provide the same coverage or costs next year.

Medicare AEP runs from October 15 through December 7. As you review your options, pay particular attention to these areas of your prescription drug coverage.

Check the formulary. A formulary is the list of prescription drugs covered by a plan. Formularies can change, so don’t assume that a medication covered this year will be covered in exactly the same way next year. Make a list of the prescriptions you currently take, including dosages, and compare them with the plan’s coverage for the coming year.

Look at drug tiers. Covered medications are generally organized into different tiers, which can affect what you pay. If one of your prescriptions moves to a different tier, your copay or coinsurance could change even though the medication remains covered.

Review the pharmacy network. Where you fill your prescriptions can also affect your costs. Some plans have preferred pharmacies where covered medications may cost less. Make sure your usual pharmacy will continue participating and determine whether another in-network or preferred pharmacy could offer lower costs.

Watch for prior authorization and other requirements. Some medications require prior authorization before a plan will cover them. Plans may also impose quantity limits or step therapy requirements. These rules can change, making it important to investigate them before the new plan year begins.

Consider the deductible. Review whether your plan has a prescription drug deductible and how it applies to your medications. Don’t evaluate the deductible by itself. Consider it alongside premiums, copays, and coinsurance to develop a better picture of your potential annual costs.

Finally, estimate your overall prescription expenses. A plan that looks affordable isn’t necessarily the least expensive choice if your medications carry higher out-of-pocket costs. Your personal prescription list can make a significant difference when reviewing plans.

Your Annual Notice of Change can help you identify updates to your existing coverage. However, you don’t have to sort through these details alone.

Before or during Medicare AEP, contact us for assistance and connect with a licensed insurance agent. Medicare beneficiaries generally do not pay an additional fee for a licensed insurance broker’s guidance. We can help you review your medications, prescription coverage and costs, and determine which available options fit your healthcare needs for the coming year.