We oftentimes hear pharmacists tell us that their patients are happy with their current Part D plan, and they are not interested in switching plans. If the patient truly is knowledgeable about Medicare and their available options, that’s great! However, statistics show that Medicare patients are generally less informed about their Medicare Part D plan options than they let on, and there are a variety of circumstances under which a patient can switch plans outside of Open Enrollment.

In a 2012 study by the Kaiser Family Foundation, researchers found that almost 2/3 of respondents claimed their understanding of Medicare was “not much at all” or “not at all”. A 2011 study by UnitedHealthcare confirmed these findings with about 39% of participants claiming their capacity to maneuver Medicare was “fair to poor” at best. The Kaiser Family Foundation study went on to uncover that only 5% of respondents correctly identified the number of plans they were eligible to enroll in.

Furthermore, only 1/3 of low-income patients even know that there is an Open Enrollment period while only 3/5 of all Medicare patients undergo a plan comparison annually. 80% of all Medicare patients are not on the most beneficial plan for them, and many of these patients could save more than $700 annually by doing a simple Part D plan comparison, so there are a huge number of patients who could be saving large sums of money and do not even know it.

One major reason it is important to compare Medicare plans is the constantly changing formularies. Medicare plans update their formularies, drug costs and reimbursements every two weeks. Usually these changes are not too drastic, but over a full year, small changes in pricing or coverage could cause immense differences in costs for a patient.

We are also in the age of the Baby Boomers, which means that 10,000 patients are turning 65 every day. This also means 10,000 people are going to be newly eligible to enroll in Medicare each day. If the previously mentioned statistics are any indication, these patients are likely to have little understanding of their plan options, and will turn to others for guidance. Big box pharmacies all know when their patients are turning 65 and begin marketing their plans months ahead of patients’ eligibility. These patients are a great opportunity for the pharmacy to be proactive and help their patients choose a plan outside of Open Enrollment. The iMedicare Newly Eligible Patient Opportunity can identify exactly who in your pharmacy is coming up on Medicare eligible age, so you can boost patient retention and help your new Part D patients find the perfect plan.

Your dual-eligible patients are one of the large patient populations who are eligible to switch their Medicare plan throughout the year, up to once a month. You might think these patients would be least receptive to switching, since their copays and premiums are already so low, but these patients might actually be the ones to benefit the most from undergoing a simple plan comparison. Medicare-Medicaid patients often pay a $0 premium for their Medicare plan due to the set ‘benchmark’ cost in each state. Each state sets a certain amount up to which they will fully cover the cost of a patient’s Medicare premium. If a plan’s premium is lower than this ‘benchmark’ amount, the dual-eligible patient pays a $0 premium if they choose to enroll in the plan. Dual-eligible patients are often auto-enrolled into a benchmark plan, but this plan does not necessarily cover all their drugs or provide fair reimbursement to the pharmacy. There are 226 benchmark plans across the 50 states, so it is imperative that pharmacists help their dual-eligible patients find the best plan for themselves. iMedicare’s new version can help customers using certain pharmacy software systems identify their dual-eligible patients in order to proactively reach out to these patients and help them switch to better plans. The below figure from The Kaiser Family Foundation illustrates the number of Medicare Part D Benchmark Plans by region for 2016.

Who else can switch outside of Open Enrollment? Patients who:

  • Move to a new service area or within the same service area, but are not provided more plan options at their new address
  • Move back to the US after residing outside of the country
  • Just moved in, out or currently reside in a skilled nursing or long-term care facility
  • Were recently released from jail
  • Are no longer enrolled in Medicaid
  • Lose coverage from their employer or union
  • Are enrolled in a PACE plan
  • Are enrolled in a plan which Medicare has officially sanctioned
  • Qualify for extra help
  • Are enrolled in SPAP
  • Is interested in enrolling in a SNP
  • Is currently in an SNP and no longer has the special needs condition

By encouraging your patients to take a look at their Part D plan options, you are building a more personal and intimate relationship with them, that a big-box pharmacist cannot do. It is a service added in your pharmacy that shows patients you truly have them and their health as your first priority as their independent pharmacist.