Your Part D Annual Review: Sitting Down With the Pill Bottles

Of all the fall Medicare tasks, this is the one I find left undone. People check the premium, see last year's number, and assume nothing changed.

But a drug plan's formulary - its list of covered medications - is rewritten for every plan year. Medications move between tiers, restrictions get attached, and some come off the list entirely. None of that shows up in the premium.

Start with the bottles, not with memory. Line them up on the kitchen table - everything you take regularly, including what a specialist prescribed months ago.

Write each one down the way the label says it, not the way you say it at home; a shorthand name is not enough to look up. Inhalers, eye drops, creams and injections belong on the list too.

Your plan tells you in writing. The Annual Notice of Change - the ANOC letter - is expected by around September 30, and it describes what changes on January 1.

Next year's drug list is published as well, usually on the plan's website. Set it beside your medication list and the setup is done.

Go down your list one line at a time. First: is the medication on next year's list at all? Second: what tier is it on, and is it the same tier as this year? Tiers are the groupings a plan uses to set your share of the cost, so a move between tiers can change what you pay.

Third, the one people miss: are there new restrictions attached? Plans use three common ones, with names most people have never had explained.

This step gets skipped most, because a pharmacy feels like a fixed part of the neighborhood. It is not - it is part of the plan's arrangements, renegotiated each year.

Plans have network pharmacies, and many designate some as preferred, where your share of the cost is set differently. A pharmacy can leave the network, or stay but leave the preferred group. Mail order works the same way.

The government publishes free tools for exactly this. The Medicare Plan Finder at Medicare.gov lets you enter your medication list - each drug, its dose, how often - along with your pharmacy, and shows how the drug plans in your ZIP code handle it.

That is why Step 1 matters: the tool is only as accurate as the list you give it. If you would rather use the phone, 1-800-MEDICARE answers around the clock, with interpreters. Both are free government resources, run by Medicare itself.

Nothing has to be settled that evening. Finding something is the point, and finding it in October is far easier than finding it at the pharmacy counter in January.

People here generally look at three kinds of options, and which one fits depends entirely on the person - the medication, your prescriber's judgment, your health history, and how well the rest of the plan still suits you. I will not tell you which is right for you.

Part D now has an annual limit on what you pay out of pocket for covered drugs. Once your out-of-pocket spending on covered Part D drugs reaches it in a calendar year, you pay nothing more for covered drugs for the rest of that year.

There is also the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into monthly payments across the year instead of paying larger amounts at the counter. It does not lower what you owe - it changes when you pay it - and you have to opt in through your plan.

The Annual Enrollment Period runs October 15 through December 7, and what you decide then takes effect January 1. December 7 is the deadline, and waiting until the first week of December means doing all of this in a rush.

Bring the pill bottles themselves and the letter from your plan. We go through the list one medication at a time, in Korean, at whatever pace suits you. That checking - whether the doctors you see are in network and whether the medications you take are covered - is the work I do.

Adult children are welcome to join or to call for a parent; many conversations start with a daughter in Orange County calling about a letter that arrived at her mother's house. Consultations are free.