Medicare Advantage

Check Your Drug Coverage for 2018 

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Open enrollment for 2018 Medicare plans runs from October 15 through December 7 this year. Whether you’re signing up for the first time in a Part D drug plan or you’re switching from original Medicare to Medicare Advantage, you’ve got a lot of decisions to make over the next eight weeks. One of those decisions is what to do about your prescription drug coverage. Before you decide which Medicare plan you want to go with, you should make sure that your medications are included with your premiums.

Checking the Formularies

A formulary is a list of medications that your insurance agrees to cover, broken down by type of medication and how much of the medication you will have to pay for. Medicare and Medicare Advantage plans generally have very low prescription co-pays, but they change their formularies every year. It’s important for you to check your plan’s formulary to see if it still covers the medications that you need. If it doesn’t, it’s time to shop around. Even if it does, though, it’s always a good idea to shop during open enrollment to get the best deal for your needs.

Making Changes If You Need To

The reason open enrollment is so important for Medicare is because it gives subscribers the chance to make sure that they have a plan that fits their needs. Formularies change every year, and you should never automatically renew your Medicare or Medicare Advantage plan without first reading the formulary to make sure your medications are still covered.

Don’t wait to review your coverage and make changes if needed. If you take no action, then you could be automatically renewed in your current plan, which may not cover your medications. Use the open enrollment period to make sure that you have all of the coverage you need for all of your medical issues.

What About Special Medications?

Most Medicare enrollees choose their Part D or Medicare Advantage drug plans because their formularies have the specific medications they need. What should you do if that special medication suddenly disappears from your current plan’s formulary and doesn’t show up in any other plan? If you can’t find an affordable plan that covers all of your drugs, talk to your doctor about switching medications, using a generic alternative or finding other ways to save on non-covered prescriptions.

Formularies are created by medical and pharmaceutical experts. If your medication has been removed from all lists, there has to be a reason. One of the most common reasons is that a substitute or new generic medication has been introduced that works better and costs less. If your formulary no longer has your special medication, start talking to your doctor now about a replacement and see if the replacement is on the list. In most cases, there is a substitute.

If you and your doctor absolutely agree that your special medication is the only way to treat your condition, then your doctor can request a formulary exception on your behalf. In the Medicare system, a formulary exception can be requested for a Medicare Advantage or Part D drug plan allowing the addition of a medication to a formulary specifically for certain patients. It’s not an easy process, and sometimes Medicare will respond by recommending an alternate medication, but it is worth trying.

As open enrollment for Medicare and Medicare Advantage gets underway, beneficiaries should take this time to conduct diligent research about the drug plans available to them. Never renew your current plan without reading the details first. Your plan formulary might be changing in 2018, and that could affect the way that your doctor treats ongoing and new conditions.

Instead of renewing without reading, you should discuss your plan’s 2018 formulary with your doctor and decide if it fits your needs. If not, then you can do the necessary research to find the Medicare or Medicare Advantage plan that does have the formulary you need.