Oct 6, 2020,11:25am EDT Diane Omdahl Contributor
If you have a Medicare Advantage or
Part D prescription drug plan, you’ll want to read this post.
By now, you should have received an
envelope labeled with “Important Plan Information” in bold type. If you’re like
most, you probably don’t recall getting this notice, which can be 15-30 pages
or more, depending on your plan and the changes, or you didn’t pay
attention.
By law, sponsors of Medicare
Advantage or Part D drug plans must send an Annual Notice of Changes (ANOC) to all
plan members at least 15 days before the start of Open Enrollment on October
15. This notice outlines changes in the plan’s benefits, coverage, formulary,
premium and/or costs that will take effect January 1. It is your chance to
determine whether your plan will meet your needs and be cost-effective in 2021.
If you determine the plan won’t work, you have the chance to check out other
plans and make a switch by December 7. If you don’t pay attention, the plan
will renew automatically and then you’re stuck with the changes for another 12
months. (Sometimes experience is the best teacher. Last year, many missed the
fact that the premium of their drug plan would double.)
The Centers for Medicare and Medicaid
Services (CMS) sets some very specific requirements, including
formatting, adding a logo, renumbering sections, and providing a table of
contents. Every plan’s notice looks very much the same. Because this is an
important document, you need to read it and be able to interpret it.
Understanding the notice
Here are some tips for what you’ll
find in the notice and why it’s important.
·
Checklist of what you should do. The first two
pages summarize the process for plan review and the questions you should
answer. Basically, determine the impact of any changes in your plan, compare
your plan to others, and choose whether to keep it or make a change by December
7.
·
Summary of important costs for 2021. This section
compares this year’s costs with what you’ll pay in 2021. For a Medicare
Advantage plan, the page notes monthly premium, health plan deductible, maximum
out-of-pocket limit and cost sharing for hospital stays and doctor
visits. For Part D drug coverage, either a stand-alone plan or as part of
a Medicare Advantage plan, the page notes monthly premium, drug deductible and
cost sharing (copayment or coinsurance) during the Initial Coverage
payment stage. (Costs during the Coverage Gap (donut hole) and
Catastrophic Coverage are the same across all plans.)
Summary of Important Costs 65 INCORPORATED
·
Table of contents. This list of topics is
customized by each plan. The most important information will likely be in the
changes to benefits and costs next year.
Table of Contents 65 INCORPORATED
·
Details by topic. Details for each topic follow
the Table of Contents and alert you to changes. Unfortunately, you will likely
have to go to the plan website to learn more specifics. For example, “There are
changes to the network of pharmacies for next year. An updated Pharmacy
Directory is located on our website at ….” Or, “A copy of our Drug list is
provided electronically. We made changes to our Drug List, including changes to
the drugs we cover and changes to the restrictions that apply to our coverage
for certain drugs.”
·
Deciding which plan to choose. You’ll find how
to proceed for any decision you make. If you decide to enroll in a different
plan, you will be disenrolled from your current one. If you want to drop an
Advantage plan and return to Original Medicare, you can call Medicare.
·
Deadline for changing plans. If you want
to change to a different plan, you can do that at any time between October 15
and December 7.
If you didn’t get a notice from your
plan, call a customer service representative today. If you did get one but
didn’t read it, dig it out of your recycling bin. Plans can make big changes to benefits, coverage and
costs. You need to know about those changes now so you can make good
decisions and ensure the best coverage for yourself in 2021. If you don’t pay
attention, you’ll keep the plan you have through 2021, for better or worse.
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