Question: I signed up for a new plan for next year, and I have my new cards for the new plan. When do I stop using my old cards? Do I show my new cards now?

Answer: Well the Annual Open Enrollment Period has ended. This is the time of year when you may have two sets of insurance cards. One set for the insurance that you have had for all of 2017 which is still covering you today, as well as the new insurance cards that you chose for 2018. We could call this the ‘Lame Duck’ period of insurance coverage. Only it really is not.

This month of December is still in 2017, so the insurance cards that you have been carrying all year are still in full operation. They will continue to cover your medical procedures and your prescriptions with no problems all the way until 12-31-17 at midnight. If you need medical care or if you need new prescriptions or refill prescriptions, you continue to use your current insurance to fill them until 12-31-17 at midnight.

As of 1-1-18 at 12:01 am, your NEW insurance cards begin to cover you. At that time, you begin to use those new insurance cards for the new company you chose to enroll in for 2018.

Right now, you have all the material and cards for both plans, as well as all the cards for the old and new plans, so you must be careful of what you use. The 2017 cards are still used now, and the new plans are not used until 2018.

Once we have all reached 1-1-18, you can take those 2017 cards out of your wallet or purse and put the new ones in. You can put those 2017 cards in the file cabinet that I hope you have for all your records. I do not recommend throwing out or destroying the 2017 cards. You may need to reference that information in the months ahead, but probably not. Most people have no problems with billing related to medical care, but sometimes it happens, so I recommend people keep the old cards for a bit. You can take a permanent marker and write the year 2017 on it, so you know when you had that coverage. I recommend keeping those types of records for at least two years.

Often individuals ask me about filling medication in December. Some individuals regularly get a 90-day supply of their medication. So if you need a refill in December, can you still get a 90-day supply? In most situations, the answer to this question is yes, you can. The insurance companies at this time do not restrict the access to that 90-day supply. I guess they figure it does not cost them a huge amount to cover those meds and most people let the insurance carry over from year to year, so they do not lose money. Also, they may get new enrollees who have filled a 90-day supply with their old plan, so the expenses wash out over all the enrollees they have.

So, if a 90-day supply makes sense for you, go ahead and fill it. There might be some situations where it does not make sense to fill the medication though. For those individuals who are currently in the coverage gap, (“Donut Hole”), they may want to fill only a 30-day supply of their medication before the end of the year. During the Coverage Gap you pay more for most medications, so it could cost your household more money to fill those medications in 2017 than it would in 2018. Those could also be medications you won’t be using until 2018.

In January of 2018, you may have a plan with a deductible and during that deductible, you could be paying 100% of the cost of the medication. If your 2018 plan does NOT have a deductible, you will be saving money to wait and get your medications filled in the new year and the new initial coverage phase of the plan. To give a concrete example of this situation: Say you take Eliquis which costs about $400 monthly, and Atorvastatin which costs about $7.15 monthly at full cost. Having taken those two medications all year, you are now in the coverage gap. That 30-day supply of those medications in the coverage gap costs around $160 for Eliquis and $3.65 for Atorvastatin. So to fill them both for a 30-day supply in December would be just under $164.

If you wait and fill them in January, you are in a new calendar year of coverage. If the plan you chose has a deductible ($405), you will pay 100 percent of the full cost that first time ($400 for the Eliquis and $7 for the Atorvastatin). If you have a plan without a deductible, you may pay $47 for Eliquis and $0 for the Atorvastatin. In this situation, a plan with a deductible will be MORE expensive for that first fill. A plan without a deductible is less that first fill. If you don’t fill a medication the first month, the deductible in this situation is not skipped: it is just postponed until next month.

There is also the factor of EPIC coverage. EPIC is the Elderly Pharmacy Insurance Coverage that is available to those that live in New York State, are over 65 and make less than $75,000 for a single person or $100,000 for a married couple. Sometimes EPIC helps you more at the end of the calendar year with your medication costs, so that I would encourage you to fill the medications now benefiting from that extra EPIC help.

There are times when I get pretty complicated with what we call “Medicare Math.” It is sometimes easier for you to ‘simply fill the medications when you need them filled’. I definitely agree with that thinking. For other people they enjoy thinking about different ways to spend/save money. You can decide which is more in line with your system of decision making.

I just want to remind you to be sure you are using the correct cards in the correct calendar year. These plans are almost always calendar year plans, so when Jan. 1 rolls around be sure you have the correct cards in your wallet and that you show them to the Pharmacy, Providers and Hospitals you use, especially the first time you go for medical care or fill a medication at the pharmacy.

Also remember to hug or say Thank YOU to that Pharmacists. January is their most difficult month, so make sure they know you appreciate their hard work!

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.