I spoke at a community event last evening and ran into a lovely lady that illustrates very well what we run into on a daily basis. I could tell I had hit a nerve by watching her body language and how she dominated the Q&A section immediately following my remarks.
I was talking about how you must manage Medicare plans. This is true mainly because of Medicare Part D. This is the part that covers prescription drugs. These plans are sold by private companies that are contracted by Medicare. They create and maintain formularies (lists of covered drugs) that can change from plan year to plan year. As time goes by, the formulary can change dramatically with new drugs being added, others deleted or being offered in generic form. Over time, if you do not adjust plans, you might find yourself in a plan that has literally been phased out or just no longer covers your medications very well.
Another item that can change are doctor networks. Doctors are constantly making changes to the insurance plans they will accept. In most cases, you do not need change doctors if you don’t want to. If a doctor decides not to accept a plan for the coming plan year, there are almost always other plans available in the area that they will accept.
The lady at my event was having both problems. In talking, she has been in the same plan for 4 years. Over the past couple of years, she has had to change doctors a couple times and is noticing that her drug coverage is changing so that she is paying more and more out of pocket. The primary reason this is happening is that her Medicare plan is not being “watched” or “managed” as it changes. As a result, she is sitting in a plan that is morphing away from her.
When I sit with her, I am going to get her preferred doctor back and situate her in an updated plan that works with her current drug list. Yes, it is usually that easy. The only potential challenge will be enrollment. Because we are currently in “lock in” for Medicare Advantage and PDP plans, she will need a specialized reason to enroll in the off season (called an SEP). If we cannot qualify her for an SEP, we will just have to wait until AEP in the fall. Either way, she is going to get some relief.