Get ready to be bombarded with mailings and TV ads for Medicare plans. Open enrollment for Medicare Part D and Medicare Advantage plans runs from October 15 to December 7, so this is your opportunity to reassess your coverage for 2017. Even if you’re happy with your plan, you may be taking a new drug or your plan’s coverage may have changed. New plans may have entered—or your plan may have left—the business in your area. Or you may want to try out Medicare Advantage, which provides both medical and drug coverage through a private insurer.
Average monthly premiums for Part D prescription-drug plans are increasing slightly—from $32 this year to $34 in 2017—but that masks some of the bigger cost increases. As drug prices rise, insurers are trying to manage their costs by dropping some drugs from their formularies, which list covered drugs, or passing along a larger share of the cost to consumers. Such changes could make the plan that was your best deal this year a less-than-optimum plan next year. “Some people with multiple chronic conditions don’t want to upset the apple cart,” says Tatiana Fassieux, board chair of California Health Advocates and a longtime counselor with the state’s health insurance assistance program. “But this year, we’ve found the formularies have changed significantly, not just in what they cover but also in how much they charge.”
You may need to pay 30% or more of the price of expensive specialty medications—or as much as 50% if you don’t use a certain pharmacy. “Some plans have been moving cancer drugs to a higher-cost pricing tier,” says Kirsten Sloan, senior policy director for the American Cancer Society. You may even have to pay a lot more for a few generic drugs, which can cost the same as brand-name drugs under some plans, says Fassieux. The bottom line: Your out-of-pocket costs could be vastly different depending on the plan you choose.
You’ll get the first clues about changes to your plan’s cost and coverage in the plan’s Annual Notice of Change, which must be mailed in late September. Then you’ll be able to compare 2017 plans using the Medicare Plan Finder starting on October 1. Type in your zip code, drugs and dosages, and the tool calculates your total costs (premiums plus out-of-pocket costs for your drugs) for each plan in your area. The best plan for you may be different than it is for your spouse.