Medicare Enrollees With Drug-Plan Problems Get a Do-Over

What You Need to Know

The famous Medicare annual enrollment period is over until October.
The lesser-known Medicare Advantage enrollment period is in progress right now.
Clients whose drug coverage needs have changed might want to make a switch.

Some older clients who were happy with their Medicare coverage a few weeks ago are looking more carefully at their prescription benefits and finding … problems.

One client wants a particular form of insulin. Another needs a new miracle drug with no generic competition. A patient’s out-of-pocket cost for a drug might be $50 per month at one plan and high enough to infuriate a high-net-worth client at another plan.

If you sell Medicare plans for a living, you know the “secret” solution. If you’re just starting to learn about the subtleties of Medicare, the answer is: the other Medicare plan enrollment period.

Thanks to the seriously underpublicized annual Medicare Advantage open enrollment period, which runs from Jan. 1 through March 31, clients unhappy with their prescription benefits “can switch to a new Medicare Advantage plan better suited to their needs,” according to Bob Rees, chief sales officer at eHealth, a company that helped create the online health insurance sales industry.

Medicare Advantage open enrollment period basics: The better-known Medicare plan annual election period runs from Oct. 15 through Dec. 7 every year. Big stars promote that enrollment period on TV. It gives anyone eligible for Medicare a chance to sign up for any Medicare Advantage plan.

The annual Medicare Advantage open enrollment period is different. It gives clients who already have Medicare Advantage plan coverage a chance to switch to different Medicare Advantage plans, or back to original Medicare with a stand-alone prescription drug plan.

Using the other, lesser-known enrollment period can help clients switch to plans with “formularies,” or lists of covered drugs, that do a better job of meeting their prescription needs.

The plans: Under existing rules, Medicare plans update their formularies all that time.

Plans may make the moves to take advantage of good deals from manufacturers, hold down their costs, increase profits and encourage patients to use drugs that should improve their overall health.

Plans are supposed to warn enrollees about formulary changes.

But “some people who maybe didn’t review their options or pay much attention during Medicare’s fall annual enrollment period are only realizing now, in January, that drug benefits under their current plan have changed and no longer a great match for their needs,” Rees said.