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Shopping my Plan During AEP

Get AEP Ready – Everything you need to know about AEP Shopping – 36 mins

How to Shop Prescription Drug Plans on Medicare.gov – 29 mins

How to Shop Medicare Advantage Plans on Medicare.gov – 33 mins

Differences between Medicare Supplement and Medicare Advantage – 15 mins

Medicare Part D Prescription Drug Coverage

This can be purchased as a standalone plan or included in your Medicare Advantage Plan.

Medicare Part D is designed to coverage prescriptions drugs which are filled at a pharmacy and taken by the patient in a home setting. This coverage is often simply referred to as Medicare Prescription Drug Plans or PDP.

The plans are not designed to cover over the counter medications, vitamins, or medications which are used for cosmetic purposes or those for which there is a comparable over the counter version available such as cough medications or some allergy medication. While Medicare Part D is offered by private insurance carriers, Medicare does set rules regarding their coverage and they must be authorized by Medicare.

Every Medicare Part D Prescription Drug Plan (PDP) will have 4 stages of coverage dependent upon how high your medication costs may become during the year.  Regardless whether you purchase a standalone PDP or you have a PDP coverage through your Medicare Advantage Plan, you will have 4 stages of coverage.

However, Part D coverages may have different formulary lists (which medications they cover), tier rankings (cost sharing assigned during the Initial Coverage Stage), and network pharmacies.  Some plans may have quantity limits (QL), prior authorization (PA) or step therapy (ST) restrictions on medications.

For more detailed information on Medicare Part D Prescription Drug Plans and how the stages of coverage work, please visit our Part D Informational Page.

Medicare Part D Standalone Prescription Drug Plans

Most Medicare beneficiaries find it is helpful to review their standalone PDP each year to make sure their coverage is still appropriate.

If you are content with your current plan, simply check with the plan to make sure that all of your medications are still listed on the formulary, are listed in the same tier, and do not have any new restrictions. Also confirm the new premium starting on 1/1 and if your chosen pharmacy still partners with the plan as a preferred to standard pharmacy.  If your coverage is still agreeable, then you can DO NOTHING and your plan will automatically renew with the new premium and benefits.

If you are not happy with your current plan, please watch our video on “How to Shop your Prescription Drug Plan on Medicare.gov” at the top of the page.

Medicare Advantage Plan

Medicare Advantage Plans (a.k.a. Medicare Part C Insurance) work as your primary insurance to replace Medicare A and B.  However, you are still responsible for paying your Medicare Part B premiums. 

Medicare Advantage Plans are plans which included both your medical/health coverage as well as you prescription drug coverage and even some ancillary benefits like dental, vision, hearing, and gym memberships. It is important to understand, the prescription drug coverage is still a Medicare Part D Plan and thus still must follow the rules for such coverage set by Medicare.

For more detailed information, please visit our Medicare Advantage Informational Page.

If you are content with your current plan, simply check with the plan the new premium and to make sure there are no major changes with your medical cost sharing or restrictions on your care (such as referrals, quantity limits, prior authorizations etc.), all of your medications are still listed on the formulary, are listed in the same tier, and do not have any new restrictions.  Confirm your chosen pharmacy still partners with the plan as a preferred to standard pharmacy.  You should also confirm via the plan’s provider look-up tool, your providers will accept the exact name of your plan (although please know networks may change at any time throughout the year).  If your coverage is still agreeable, then you can DO NOTHING and your plan will automatically renew with the new premium and benefits.

If you are not happy with your current plan, please watch our video on “How to Shop your Medicare Advantage Plan on Medicare.gov” at the top of the page.

Understanding the differences between Medicare Supplement and Medicare Advantage…

Both Medicare Supplement and Medicare Advantage can be attractive coverage options when you are enrolled in Medicare.  Please watch our video on “Differences between Medicare Supplement and Medicare Advantage” at the top of the page.

What is most attractive to you will depend on your individual preferences.

When can you change?

From Medicare Supplement to Medicare Advantage – No Medical Questions required.
  • During the Annual Enrollment Period from 10/15 to 12/7.
    • Your policy will be effective 1/1.
  • You will need to contact your Medicare Supplement Company to cancel once you are approved.
  • You do not need to cancel your current Part D Plan because it is automatically cancelled by your Medicare Advantage enrollment.
From Medicare Advantage to Medicare Supplement – Medical questions will apply.
  • During the Annual Enrollment Period from 10/15 to 12/7.
    • Your policy will be effective 1/1.
  • OR: During the Medicare Advantage Open Enrollment Period from 1/1 to 3/31 –
    • Policy can be effective the first of the month of your choosing (after approval) between 2/1 and 4/1.
    • If you want to work with a rep directly, HTA can help with this between 1/1 to 3/31 each year.  Please call for an appointment.

Do not cancel your Medicare Advantage Plan until you have a formal approval from the Medicare Supplement insurance company

  • If you do not receive an approval by 12/7, you will need to renew your Medicare Advantage Plan for 1/1 and wait for the approval. You will then need to change your Medicare Supplement effective date to either 2/1, 3/1, or 4/1.

If you are enrolling in a Medicare Supplement Plan, you will also need Medicare Part D prescription drug coverage.

  • Once approved, you can cancel your Medicare Advantage by enrolling in a standalone PDP.
  • Please remember do not do this unless you know you are formally approved for your Medicare Supplement (or you will be transitioned back to Original Medicare Only and can only add a Medicare Advantage Plan again during the Annual Enrollment Period from 10/15 to 12/7 each year.

Already an existing HTA Client?

If you have 1 or more Medicare related policies through HTA, HTA also offers a 45 minute free phone consultation to review your questions, shop for the most appropriate plan and assist in your enrollment.  Please contact 610-430-6650, option 1 to schedule an appointment.