Oct 20 2021

Medicare Open Enrollment is Underway – Help Ensure Your Patients are Covered!

Medicare's annual open enrollment period began on October 15 and will run through December 7. During this time, Medicare patients can review their current health and drug coverage, and potentially switch to a plan that offers more suitable benefits. New program coverage will become effective on January 1, 2022.

This includes the opportunity to change Medicare Part D drug plan coverage. The Centers for Medicare & Medicaid Services (CMS) encourages all Medicare beneficiaries to review their current plans, even if they are satisfied with its existing coverage. That's because plans are continually changing, which means benefits are not necessarily carried over from one year to the next.

As patients consider their options, pharmacists will undoubtedly receive inquiries. Following are a few tips that can help with plan-related conversations, and assist beneficiaries in choosing the most appropriate plan"

  • Most Medicare beneficiaries are not on the correct plan. 2021 research conducted by eHealth found a shocking 94 percent of beneficiaries were not enrolled in the optimal Medicare plan for their prescription drug needs. This survey also found that by enrolling in the optimal plan, the average beneficiary would save more than $760 per year. These figures drive home the importance of ensuring each beneficiary is on the correct plan. Most beneficiaries don't take advantage of the Open Enrollment opportunity to consider their  options. The pharmacist, as a trusted health care team member, can be an important voice in raising patients' awareness about the need to review plan benefits, and evaluate options.
  • Many Plans are Changing for 2022. In late September, CMS released the 2022 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans. The average premium for Medicare Advantage plans will be lower in 2022, at $19 per month, compared to $21.22 during 2021. The average 2022 premium for Part D drug coverage will be $33 per month, an increase from the average $31.47 during 2021.
  • Check eligibility for Medicare Savings Programs. An increasing number of patients are eligible for Medicare Savings Programs, operated at the state level. According to CMS, these programs can help save money on premiums, prescription drugs, and other health costs. During 2021, individuals with income below $18,000 qualified for special savings. Pharmacists can make sure patients are aware of this possibility and advise them to contact their state's Medicare office.
  • Patients can easily compare plans. CMS allows beneficiaries to do side-by-side comparisons of costs and coverage. Patients can access this helpful tool on the website. In addition, CMS maintains a dedicated helpline, 1-800-MEDICARE. Trained assistance is available 24 hours a day, including during weekends. Pharmacies can help patients analyze the plan comparisons. This includes determining if a patient's medications are covered, along with out-of-pocket costs. At the same time, FDSAmplicare points out, pharmacists can use the plan comparison tool to evaluate which plans negatively affect their bottom lines due to low reimbursements and DIR fees. This is essentially a "win-win" scenario: Pharmacists can determine plans that best meet patient needs, and those  that unfairly offer low reimbursement rates.

The Open Enrollment period provides an opportunity for Medicare patients to ensure their plan best meets their needs. But understanding various plan options can be confusing. Which is why many patients choose to keep  their current coverage, even though better options may be available. Pharmacists can help and, in the process, look out for their own bottom lines.