Today is the big day!

The annual Open Enrollment Period (OEP), runs from

October 15 through December 7.

This is when you can make changes to your Part D and Medicare  Advantage coverage.

Use the Four C’s to help you to explore your options:

Cost

• What is the total projected annual cost of the plans you are considering?
• How much are the monthly premiums charged by the plans? Have they gone up for 2015?
• If you have the low-income subsidy (LIS)/Extra Help, will your current plan still meet the low-income benchmark in 2015? If not, how much additional premium will you have to pay if you want to stay in your current plan or select a different “non-benchmark” plan?
• Is an “extra” premium worth it for a more responsive formulary and less need to request exceptions? (Remember LIS people pay the same copays regardless of Part D plan type.)
• What about other costs (e.g., copays, coinsurance, deductible) changing for 2015, and what are the consequences  for you?
• Did you enter the Part D Coverage Gap in 2014?
• Do you anticipate this happening in 2015? Are you taking brand-name drugs or generic drugs?

Coverage

• Do the plans you are considering cover all the drugs you believe you will need in 2015?
• Carefully review the prescribed strength, dosage, and route of administration and restrictions imposed by plans
•  If you received a formulary exception from your plan in 2014 to cover a  drug not on the formulary, bypass utilization management requirements, or reduce cost-sharing, what will happen for 2015 – are there plans that cover your
  drugs without limitations
• Also, call plans to confirm coverage and costs of new-to-market generic drugs that may now available and do not appear on Medicare Plan Finder.
• Do you want to have your health care and prescription drugs covered by a  single plan – then you should review Medicare Advantage options? Do you have  Medigap, Veterans, or retiree coverage?
• How do the plans you are considering  rank under the star quality rating system? Are any 5-star plans?

Convenience/Access

• To what extent will the plans under consideration restrict access to the medications  you need (through step therapy, prior authorization, or quantity limits) in 2015?
• Can you get your medications at a preferred price at the pharmacy of your choice? (Or at a pharmacy your long-term care facility uses?)
• Do the plans under consideration offer mail order delivery and are you interested? If yes, how do the 4 C’s compare between mail order and “brick & mortar” pharmacies?
• If you traveled this past year, will you be able to get prescriptions easily with the plans you are considering while you are away from home?

Customer Service

• How responsive are the plans under consideration (e.g., how do the plans handle any  problems or questions)?
• How do the plans being considered help you manage your medication needs (e.g., do they send refill reminders)? How do the plans do Medication Therapeutic Management (MTM)?
• How can you use the plans’ Overall Plan Rating in the Medicare Plan Finder as a factor? Do you understand how plan ratings are measured and scored?

Here is other useful information:

1. This is a great site. Lots of useful information: My Medicare Matters
2. Fact sheets for each State
3. Don’t be late: Medicare Part D: Late-Enrollment Penalty Premium