For 3 Million+ Medicare Beneficiaries Facing a Change in Their Part D Coverage: Here’s What to Ask

Seniors Should Know If Their Prescriptions Are Covered, If Co-Pays Will Change, and If Preferred Pharmacies Are Included in Their New Plan

BURLINGAME, Calif.--(BUSINESS WIRE)-- To eliminate confusion and simplify Medicare Part D plan coverage, the Centers for Medicare & Medicaid Services (CMS) has mandated that there must be a “meaningful difference” between plans offered by the same health insurance carrier, and if there is no difference, redundant plans must be eliminated. Meaningful difference is an actuarial estimate of the member’s out-of-pocket cost share between each plan offered. In many cases, seniors who are in a plan that is terminating will be automatically “crosswalked” into one of their carrier’s other Part D prescription drug plans.

In a few cases, carriers may simply drop the plan without automatically enrolling beneficiaries in a new plan. These individuals will have what Medicare calls a Special Enrollment Period starting October 1st when they can search for and enroll in a new plan.

According to Bryce Williams, CEO of Extend Health, Inc., which operates the nation’s largest private Medicare exchange, “Any senior whose carrier is automatically switching them into a new plan should consider three things before they accept the change:

  • First, will the new plan cover the prescription drugs I use?
  • Second, are co-pays changing for my drugs, and if so, what are the new co-pays?
  • Third, will the new plan let me purchase medications from my preferred pharmacy?”

If the new plan will increase their out-of-pocket expense, or prevent them from being able to purchase the prescribed drugs needed, Williams advises that seniors look at Part D prescription drug plans from other carriers to see if another plan better meets their needs. Seniors can change Part D plans during the annual Medicare enrollment period, which runs from November 15 through December 31, 2010. Those seniors whose plans have been discontinued or terminated can enroll in a new plan during their special enrollment period from October 1st through December 31st 2010.

An analysis by Avalere Health, a leading private research firm, estimated that more than three million beneficiaries will see their prescription plan eliminated as part of a new effort by CMS to offer consumers more meaningful choices.

“We have helped hundreds of thousands of retirees choose the best private Medicare plans by encouraging competition and letting seniors compare plans side-by-side in our exchange,” said Williams. “This reduction in the number of Part D plans is generally a good thing by the CMS because it is simply taking redundancy out of the market. Still, seniors should protect themselves by making sure they understand the Part D plans that are available to them from all carriers in their area.”

About Extend Health:

Extend Health, Inc. was founded in 2004 to serve Medicare-eligible retirees and their corporate sponsors. The company operates the country’s largest private Medicare exchange and has helped more than 250,000 retirees compare and choose the private Medicare plan that best meets their needs and budgets. With Extend Health employer solutions, Fortune 500 companies, unions, and municipalities can save up to 35% on retiree health care compared to legacy employer group plans. For more information, visit Extend Health on the web at


Extend Health, Inc.
Aaron Berger, 917-355-8959
[email protected]
Rob Wyse, 212-920-1470
[email protected]

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