Medicare answers: flu shot coverage, comparison-shopping for drug plans

The Medicare Rights Center provides answers to your Medicare questions each month in “Marci’s Medicare Answers.”

Dear Marci,

My doctor told me that I should get a flu shot since it is the start of flu season. Does Medicare cover the flu shot?

—Darlene

Dear Darlene,

Yes, Medicare Part B covers a flu shot once every flu season. It covers 100 percent of the costs, with no Part B deductible required, whether you have Original Medicare or a Medicare Advantage plan.

If you have Original Medicare, Medicare covers the flu shot no matter where you get it, as long as the health care provider giving the shot is enrolled in Medicare. If you have a Medicare Advantage plan, the plan may require you to get your flu shot from a provider in the plan’s network. Call your Medicare Advantage plan with questions regarding plan networks.

Flu season usually runs from November through April, so Medicare could cover more than one flu shot in a calendar year. For example, you can get a flu shot in January 2014 for the 2013/2014 flu season, and then get another shot in November 2014 for the 2014/2015 flu season.

Medicare also covers other vaccines to prevent illness, such as pneumonia and Hepatitis B. You can call Medicare at 800-Medicare or speak with your primary care doctor to ask whether Medicare will cover a specific vaccine.

—Marci

Dear Marci,

I know that we are now in the Medicare Fall Open Enrollment period. Should I change my Part D coverage during Fall Open Enrollment?

—Allan

Dear Allan,

You should investigate your Part D plan options for the coming year during Fall Open Enrollment, which happens every year from October 15 to December 7. Even if you are satisfied with your current Part D drug coverage, you should check to see if there is another plan in your area that will offer you better drug coverage at a more affordable price. Research has shown that people with Medicare Part D plans could lower their annual costs by shopping around for plans each year.

In order to do this, review your Annual Notice of Coverage (ANOC) and/or an Evidence of Coverage (EOC) letters from your plan, which you should receive in the early fall. This letter will tell you of any changes to plan costs, such as premiums or copays, for the following year. It will also describe any adjustments made to the plan’s formulary, or list of covered prescriptions. If you are unhappy with any changes, you can choose a new plan during Fall Open Enrollment. Any changes that you make during this time go into effect on January 1 of the following year.

You can use the Plan Finder tool on the website www.medicare.gov to find out more about different plans. You can also call 800-Medicare to learn more about plan options. Once you have information about different plans, call the plans directly to verify the information that you receive from Medicare. When you are ready to enroll in a new plan, the best way to do so is by calling 800-Medicare. This will help to protect you in case there are any issues with enrollment.

Only 13 percent of people with Medicare actually make changes to their Part D coverage during Fall Open Enrollment, but many more should do so. Reviewing your coverage and looking at other plan options in your area are important steps to make sure that you are getting the prescription drug coverage that best meets your needs.

—Marci

Dear Marci,

I just received the Extra Help benefit for prescription drugs and was told that I would be enrolled in a Part D benchmark plan. What is a benchmark plan?

—Martha

Dear Martha,

Extra Help is a federal assistance program that helps people with limited income pay for their Medicare prescription drug costs. When you have Extra Help, you will automatically be enrolled into a benchmark plan. Extra Help will only pay premiums up to a certain amount in each state. A benchmark plan is a Part D plan that your state has designated as having a monthly premium either at or below the monthly amount that Extra Help will pay.

Though you will automatically be enrolled in a benchmark plan when you have Extra Help, you still can choose a benchmark plan that best meets your needs. It is best for beneficiaries to research plans and enroll in one with a formulary that covers all of their prescription drugs. If you have Extra Help, you also qualify for a Special Enrollment Period once per month to switch your prescription drug plan.

If you have questions about benchmark plans in your state, or have questions about the Extra Help program, call your State Health Insurance Assistance Program (SHIP) for more information. To find your state’s SHIP, visit www.shiptalk.org.

Keep in mind that if you have Extra Help, you can enroll in a plan that is not a benchmark plan; however, you will likely have to pay the difference between the cost of the plan and your state’s benchmark premium.

—Marci

Marci’s Medicare Answers is a service of the Medicare Rights Center , the nation’s largest independent source of information and assistance for people with Medicare.