Five Things You Should Remember about Medicare Advantage and Prescription Drug Plans

Since Medicare Advantage and Prescription Drug plans run on a calendar year you may not remember or know this:

1. If you have enrolled in an HMO plan, you must select your preferred primary care provider, or one will be automatically assigned to you. You can change your primary at any time but going into your portal, calling the number on the back or your insurance card or contacting us.

2. Most Part D plans have an annual deductible. This year it is $505, however most plans exclude Tier 1 and sometimes Tier 2 generics from that deductible. If you go to the pharmacy and your prescriptions are suddenly much more expensive than they were last year, this may be why.

   1. The first step is to look on your plan portal or the carrier’s website to look up which tier your drug is on and what your cost will be using your plan. Then compare that to the cash price you would get by bypassing your drug plan to purchase your medications. I compare the annual cost because sometimes even with the high deductible, the overall cost for the year is actually lower on your plan.

   2. Some higher tiered generic medications are less expensive by using a www.goodrx.com , store or manufacturer coupons. If your price seems too high be sure to price out the cost using a coupon compared to using your Part D plan. There are a number of other coupon sites to consider: www.needymeds.org , www.drugs.com , www.wellrx.com

   3. To find out if your expensive, brand-named drugs have a manufacturer program, you can go to www.rxassist.org to find coupons and their qualifications.

3. Remember that all Part D plans and Advantage plans that include a drug benefit have preferred or standard pharmacies. Costs will be lower at a preferred pharmacy vs a standard pharmacy.

4. If you have changed your PDP plan for 2023, I recommend you take a couple of steps to ensure that there are no disruptions to your coverage by doing the following:

   1. If you have an Automatic Bank Withdrawal (ABW) scheduled for any of your plans, confirm that the January payment has been withdrawn from your bank account and confirm that you are set up for ongoing payments via ABW.

      1. Often the binder payments are ABW, but you must take that extra step to be sure the ongoing payments are also scheduled for ABW and your policy doesn’t lapse.

      2. You can change your payment method at any time of year by contacting your insurance provider

   2. If you have an inexpensive prescription drug plan and intended to pay for the entire year at one time, you should have received your coupon book or billing in January. Don’t forget to send that in and confirm that it was received by the carrier.

5. One of the reasons you likely signed up for an Advantage plan is for the extra benefits: dental, vision, hearing, gym membership, over-the-counter products and various rewards programs. You should have received information from your carrier on how to utilize these programs and can also find more on the carrier website, through your user portal or by contacting our office.

   1. Dental benefits on HMO plans require you use a dentist in network only, otherwise they will not cover it.

   2. Dental benefits on PPO plans can be used for both in and out of network doctors and it will be covered either way. Many dentist offices will submit your claim even if they are not in network and you can also file your receipts for reimbursement on your own.

      1. Dentist office are confused by this as it is new for some carriers this year. If you have trouble with your dentist office, we can help get your carrier involved if necessary or help you file a claim.

   3. The hearing benefit usually requires that you go through a specific vendor, such as TruHearing or NationsHearing to schedule appointments. Once there, you will have a choice of many different hearing aids up to the benefit or copay amount for your plan.