Checking Medication Coverage for Upcoming Years

Did you know your Medicare drug coverage can change every single year, even if you don't do anything? Here's what to watch for, and how we can help.

One of the most common surprises Medicare beneficiaries face at the start of a new year is finding out that a medication they rely on has been dropped from their plan's coverage, moved to a higher cost tier, or now requires extra steps before it will be filled. The good news is that this is entirely preventable if you know what to look for ahead of time.

Watch For Your Annual Notice of Change Every Fall

Each year, your Medicare plan is required by law to mail you an Annual Notice of Change (ANOC) by September 30. This document is your plan's way of telling you exactly what is changing in your coverage for the coming year.

When it arrives, pay close attention to your prescription drug coverage section. Specifically, look for:

• Any of your current medications being moved to a higher cost tier

• Drugs being removed from your plan's covered drug list (formulary)

• New requirements like prior authorization or step therapy being added to a medication you take

• Changes to your deductible or copays

Even if the notice says there are no changes, it is still worth a conversation because your health needs and finances may have changed even if your plan hasn't.

Know the Questions to Ask

When your SGIA Benefit Consultant reviews your coverage with you each year, having this information ready makes a big difference:

• A complete list of your current medications, including dosages

• Any new medications your doctor has recently prescribed or discussed

• Any changes to your health conditions over the past year

• Whether your preferred pharmacy is still covered under your plan

These details are what allow an SGIA Benefit Consultant to compare plans accurately on your behalf, looking at your real costs, not just the monthly premium.

Changes Take Place During Open Enrollment

If you are already enrolled in a plan, the most important thing to know is that Medicare has specific enrollment periods for making plan changes. For most people, that window opens each fall during the Annual Enrollment Period (October 15 – December 7). Outside of special circumstances, plan changes take effect on January 1 of the following year.

So, if you are reading this in May, no action is needed today, but this is a great time to start paying attention and make a mental note to connect with SGIA Medicare Consulting when fall arrives.

We're Here to Help You Navigate Medicare

At SGIA, our Benefit Consultants help you compare plans based on your specific medications, health needs, and budget so you never have to navigate the Medicare system on your own. Whether you are new to Medicare or a longtime enrollee, we'll make sure you're in the right plan at the right time.

Have questions about your coverage right now? Don't wait until fall, reach out any time and we'll point you in the right direction. Call us today at 888-284-3314 or visit sgiamedicare.com.