Keep the Medicare Plan Working After Enrollment: The Yearly Review Nobody Calendars
A Medicare Advantage or drug plan changes its network and its drug list on a schedule, and the family that does not review it each fall finds out at the pharmacy counter.
Enrolling in a Medicare plan is the start of a yearly routine, not the end of a decision. Medicare sets an annual enrollment window each fall, during which people can change Medicare Advantage and prescription drug plans. Plans can change their provider networks, pharmacy networks, referral rules, and drug lists from one year to the next, and the notice that describes those changes is mailed to your parent. The job of keeping the plan working falls to whoever is responsible for the family's paperwork.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Set up the paper trail
Keep a binder or a folder with the plan card, the summary of benefits, the evidence of coverage, and the annual notice of change for each plan. Medicare requires plans to send the notice of change each year, and it lists what is changing. Read the notice before the enrollment window opens, not after. If your parent wants you to speak for them with Medicare or the plan, the authorization is made on Medicare's Appointment of Representative form, and it must be signed by your parent while your parent can sign it. Keep a copy in the binder.
Check the four lines that move most
Each fall, check these items against your parent's real use: whether the doctors your parent sees are still in network, whether the pharmacy they use is still in the pharmacy network, whether the drugs your parent takes are still on the plan's drug list and at what tier, and whether any service now requires prior approval that did not before. Note any change that would affect a regular visit or a regular refill.
Decide what the family handles and what it does not
The family can track the plan, call the plan on your parent's behalf if authorized, and keep the list of questions for the pharmacist and prescriber. The family does not decide the medication, and an aide does not sort or manage it. When a drug is not covered or a substitute is offered, the question goes to the prescriber and the pharmacist. Your job is to make sure the question gets asked before the bottle runs out.
Use the free counselors each fall
Missouri SHIP counselors help people compare plans during the enrollment window at no cost, and they are a good check on the plan you are considering changing to. Bring the notice, the binder, and the list of providers and drugs. You can find local help on the Local Help With Paying for Care page. The Sources page lists the public documents this article relies on.
Where this stops
A plan review answers which plan covers what. It does not answer whether your parent needs a particular service, which is a question for the doctor. If the question is whether a change in your parent's ability to sign or manage paperwork requires a legal document, that is a lawyer's question, not a plan question.