The Importance of Checking your Medicare Plan(s)

Open enrollment is currently happening for Medicare enrollees with a drug plan and/or an advantage plan. You can make changes now through December 7th.  It is important to check that the plan(s) you have are the best ones for you.

Why check plans? 

Every year the SHIBA volunteers (Statewide Health Insurance Benefits Advisors) at ISR find some clients who are spending more than needed for their advantage plan or drug plan. 

Here are some examples:

  • Robert takes two generic drugs that are normally inexpensive.  Several years ago, he enrolled in the least expensive plan and had a co-pay of $4 every 90 days. Each year since enrollment, the plan premium increased, and the co-pays went up.  This year, the premium went up significantly.  Last fall, he neglected to review the plan’s costs and, in January 2021, learned the new premium went up a whopping $62!  And then it was too late to change plans, and he was locked in until the next open enrollment in the fall.
  • Susan has had the same plan for several years. In June 2020, her doctor changed one of her medications. Although her plan did not cover the new medication, it is required to cover mid-year changes through the end of the current calendar year.  She did not recheck her plan last fall. Result: this year, she is paying the full price – more than $357/month.  This increase in her drug cost could have been avoided by switching to a plan that included the new medication.
  • Thomas has been in the same Medicare Advantage plan for several years.  He likes his plan despite numerous changes over the years. Two of his drugs are no longer covered; instead, the plan covers similar drugs.  He failed to discuss his drug list with his doctor to determine whether he could change medications or switch to a different advantage plan that covers his current medications.
  • Richard has had the same advantage plan for several years with a few changes in benefits.  This year, his primary care provider has decided not to accept this plan for 2021. Richard did not read his provider’s letter, which described plans he would accept in 2021. Nor did he check to be sure his plan would be accepted. As a result, Richard had to find a new doctor who would accept his plan.
  • Jan has a supplemental plan and a separate drug plan.  She does not need to change her supplemental plan, but she needs to check her drug plan to ensure it is the best plan at the lowest price. If she has a favorite pharmacy, SHIBA can help her identify her best option for next year.
  • Carol has a supplemental plan which she wants to change. She can change her supplemental plan at any time throughout the year, effective the first day of the following month.  She checked her drug plan with SHIBA and confirmed it is still the best one for her, so she will keep it for 2022.

For help checking your plans and/or find new plans, contact the SHIBA volunteers at Island Senior Resources 360-321-1600 ext. or 360-678-3373 for an appointment. SHIBA stands for Statewide Health Insurance Benefits Advisors, a FREE program of the Insurance Commissioner’s Office.