Open enrollment season is nearly upon us! From October 15th to December 7th, your patients currently enrolled in a Medicare Part D plan may switch to a new plan if they desire. As October quickly approaches, we wanted to give you all of the information you would need before patients start coming into your pharmacies to compare and enroll in Medicare Part D plans.
Even if your patients are happy with their current plan, it is imperative for them to run a comparison to see if there is a better plan available. In fact, 80% of your Part D patients are not on the most affordable plan and could save over $700! Using iMedicare, you can check the patient’s drugs for restrictions and coverage. If some drugs are not covered, you can use our therapeutic alternatives tool to help the patient find an alternative, which in turn, saves them money as well.
You may also have Medicare Advantage patients at your pharmacy. During open enrollment, they are allowed to switch to another advantage plan or to switch back to original Medicare coverage. Further, from January 1st - February 14th these patients can dis-enroll in their advantage plan and enroll in original Medicare. When Medicare Advantage patients want to switch plans, they need to make sure that their current physician and other benefits are also covered on a new plan.
Not only do current Medicare patients need to find the most affordable Part D plan for 2016, but newly eligible patients have a 7-month window in which to enroll in Medicare. They can enroll 3 months before they turn 65, the month of their 65th birthday, and 3 months after they turn 65.
Beginning 63 days after a their 7-month enrollment window, patients start to accrue a penalty. This penalty will increase every month they do not have credible coverage. This is how the penalty is calculated: The Number of Months Gone Without Credible Part D Coverage 1% The Year’s Average Monthly Premium. This number is rounded to the nearest .1.
Example: Mrs. Martin didn’t join a drug plan when she was first eligible - by June 2012. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan during the 2014 Open Enrollment Period, and her coverage began on January 1, 2015.
Since Mrs. Martin was without creditable prescription drug coverage from July 2012 - December 2014, her penalty in 2015 is 30% (1% for each of the 30 months) of $33.13 (the national base beneficiary premium for 2015), which is $9.94. The monthly penalty is rounded to the nearest $.10, so she’ll be charged $9.90 each month in addition to her plan’s monthly premium in 2015.
Here’s the math:
.30 (30% penalty) x $33.13 (2015 base beneficiary premium) = $9.94
$9.94 (rounded to the nearest $0.10) = $9.90
Websites like this one can help you with the calculations.
There are additional times in which a patient can switch their part D plan. Moving to another state or into a nursing home, qualifying for extra help or qualifying for Medicaid all trigger a special enrollment period.A list of all special enrollment periods can be found here.
By understanding open enrollment, special enrollment windows and any penalty fees, you’ll be better able to balance the care of the seniors that come into your pharmacy.