This fall, Medicare Open Enrollment will begin for your eligible patients. This is the time when they can review their Medicare plan, make changes, or change their health plan. However, this can also be a critical time for pharmacies.
Many of your patients are age 65 and older, and their health care needs change with every passing year. It’s important to make sure that their health care plan suits both their medical and financial needs. Plus, different Medicare plans can have effects on your pharmacy, as well.
When Does Medicare Open Enrollment Begin & End?
Medicare Open Enrollment lasts from October 15, 2021 to December 7, 2021. During this period, Medicare patients can make changes to their plans or enroll in new plans. These dates are actually the same every year; keep that in mind for the future.
What Are the Different Types of Medicare, and What Do They Mean?
Medicare is divided into four different parts, and they each have their own functions and criteria:
- Medicare Part A covers your inpatient care in hospitals and skilled nursing facilities (but not custodial or long-term care). Part A also helps cover hospice care and even some home health care, though certain conditions have to be met to get those benefits. Part A generally doesn’t require a premium for people 65 and older, though there are conditions that might require a buy-in (see the “Who Is Eligible for Medicare” section below).
- Medicare Part B covers doctors’ visits, outpatient care, and other medical services that Part A doesn’t cover. Part B also covers some preventative services like exams, lab tests, and screening shots. Unlike Part A, Part B requires a monthly premium. And while most patients will pay the standard premium, some may have to pay more based on their income.
- Medicare Part C (Medicare Advantage) is a little bit different from the others. These kinds of plans are offered by private insurance companies and approved by Medicare. Medicare Advantage plans provide all your Part A and Part B coverage under one plan, and may even offer extra coverage like vision, hearing, dental, or health and wellness programs. Most also include Medicare prescription drug coverage (Part D). These plans also differ in cost, as the private insurance companies can charge different out-of-pocket costs and require you to follow different rules to get services (referrals for specialists, in-network services, etc.).
- Medicare Part D is Medicare’s prescription drug coverage. Everyone with Medicare, regardless of income, health status, or prescription drug usage, has access to prescription drug coverage.
Who Is Eligible for Medicare?
According to HHS.gov, Medicare is available for people age 65 and older. It is also available to people under the age of 65 if they have disabilities or if they have permanent kidney failure requiring dialysis or transplant (End Stage Renal Disease). A patient is eligible for the premium-free Part A if they are 65 or older and either they or their spouse has paid Medicare taxes for at least ten years. If those conditions aren’t met, patients 65 and older may still be able to buy into the program.
What Is a Pharmacist’s Role in Medicare Open Enrollment?
This one is tricky. Pharmacists are not allowed to recommend particular plans to their patients or enroll patients into a plan on their behalf. However, pharmacists can (and often do) help their patients understand their Medicare options, including cost breakdowns, plan benefits, and more. Pharmacists are an invaluable health resource in their communities, and patients trust them to help them choose the best plan for them.
(For more on FDS Amplicare’s Medicare plan comparison software, check out Amplicare.com!)
When you help your patients learn more about their Medicare plan options, you’re stepping out of the roll of medication dispenser and into the role of trusted care provider for your community. It’s time to show your patients that there’s more to a pharmacy than filling prescriptions. Help them with something that can make a difference in both their physical health AND their financial health.
