Q&A: Medicare Open Enrollment

Q: What is Medicare Open Enrollment?

A: Every year in the fall, individuals insured through Medicare are able to make changes in your health care and prescription drug coverage plans for the upcoming year. Open enrollment starts Oct. 15 and runs through Dec. 7. Keep in mind, in addition to traditional Medicare (Part A & Part B) that pays for hospital and provider visits, enrollees can choose from Medicare Advantage (Part C) and Medicare (Part D) drug plans to find the best coverage to fit your budget and health care needs. Open enrollment season allows people to take stock of personal medical needs and do some comparison shopping to find the best insurance plan for your individual situation. Be mindful that costs and coverage on health plans can change from one year to the next. So, be sure to cross check that the prescription medicines prescribed by your provider are on the formulary and pricing tier (a list of pharmaceutical drugs covered by a specific health plan) and confirm which providers and pharmacies are in network or considered a preferred provider. Keep in mind the pricing tier of a drug and the preferred provider status for your pharmacy can impact out-of-pocket expenses. Do your homework. Pay attention to the materials sent by your health and prescription drug plan; examine the “annual notice of change” to see if your current plan will meet your needs in the coming year. Don’t take it for granted. It’s important to take the time and go through the process. The Centers for Medicare & Medicaid Services (CMS) offer a confidential, password-protected online tool for Medicare recipients to create an account to access, store and retrieve your individual Medicare information, including a summary of your current coverage to compare plan costs with the drugs and pharmacies saved in your file. Go to Medicare.gov to sign up for important reminders and preview 2024 plans.

Q: What should Iowans know about Medicare Part D?

A: When I served as chairman of the Senate Finance Committee 20 years ago, I steered through Congress historic reforms to add the first-ever, outpatient prescription drug benefit to Medicare. When Medicare started in 1965, it provided coverage for hospital and doctor visits for people age 65 and older and individuals with disabilities. As pharmaceutical medicine became increasingly important to manage chronic conditions and provide lifesaving treatments, I worked to add a voluntary prescription drug coverage benefit with passage of the Medicare Prescription Drug, Improvement and Modernization Act. In many ways, this legislative victory was an uphill battle to get across the finish line. It took years of effort to build a bipartisan consensus to get the job done and strengthen Medicare for the 21^st century. I stuck to two guiding principles during the legislative process: improve affordable access for Medicare beneficiaries and uphold fiscal stewardship on behalf of the taxpayer. My bipartisan legislation was signed into law by President George W. Bush two decades ago on Dec. 8, 2003. Since its implementation, Medicare Part D has provided tens of millions of Americans peace of mind and helped stretch their retirement savings to fill prescriptions and make ends meets. Over the lifetime of the program, Medicare Part D participants have had an average monthly premium that ranges from $27 to $36. First-time Medicare enrollees need to be aware that choosing to delay Part D coverage comes with financial risk. Signing up for the most affordable Part D plan, at less than $5 month, is a better value on the dollar compared to the penalty formula that kicks in for enrolling years after eligibility. Part D has offered a lifeline to millions of seniors and people with disabilities to afford the medicines they need to live a better quality of life. Today, 52 million seniors are voluntarily in a Part D plan and 13 million seniors are supported with a low-income subsidy to reduce their out-of-pocket costs.

Before the ink was dry on the landmark law, I’ve worked ever since to hold the federal government accountable and implement Part D as Congress intended. Most recently, I’m laser-focused on rooting out shenanigans in the drug pricing regime that drive up costs for patients, taxpayers and employers. I’m working to flush out the murky tactics deployed by Pharmacy Benefit Managers (PBMs) to game the system and pocket profits at the expense of independent pharmacies, patients and taxpayers. My PBM Transparency Act and Prescription Pricing for the People Act have both passed out of their respective committees with strong bipartisan support. Also, the Modernizing and Ensuring PBM Accountability (MEPA) Act included several of my provisions and passed out of committee this summer with strong bipartisan support. As a champion for rural health care, I’ll continue leading the charge to ensure our rural health care providers and independent pharmacies get a fair shake so that rural Americans have access to health care that’s close to home.

Medicare Open Enrollment runs Oct. 15-Dec. 7, 2023. Iowans may contact the Senior Health Insurance Information Program (SHIIP) to set up an appointment for free, confidential assistance tailored to meet their individual needs at shiip.iowa.gov or call (800) 351-4664.