What Pharmacists Should Know About Medicare Open Enrollment 2023

The Medicare Open Enrollment period for 2023 is quickly approaching – this is a critical time for both your patients and your pharmacy. Every year, the enrollment period runs from October 15 to December 7. This leaves very little time before patients need to re-evaluate their insurance. 

Below are a few tips on how your pharmacy can prepare for the upcoming enrollment period.

About Medicare Open Enrollment 2023

Any US citizen or legal permanent resident over the age of 65 can apply for Medicare Open Enrollment. 

In some cases, patients under 65 may qualify if they are disabled and have been receiving Social Security Disability benefits for at least 24 months. Anyone diagnosed with Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease can also qualify early.

The official enrollment period ends on December 7. However, patients living in areas of declared disasters, may be eligible for an extended enrollment period.


Breakdown of Medicare types and coverage

Below is a quick summary to help your eligible patients prepare:

Medicare Part A:  Hospital insurance that includes inpatient and overnight hospital care, skilled nursing facility services, nursing home care, hospice care, and home health services.

Medicare Part B: Medical insurance for outpatient services to prevent, diagnose, and treat medical conditions, like doctor’s appointments, tests, immunizations, durable medical equipment (DME), mental health services, and limited prescription drugs.

Medicare Part C: Also known as Medicare Advantage, this is a bundled plan that combines Part A and B and Part D services. Part C also includes add-on services like vision, dental, and hearing.

Medicare Part D: Additional coverage for Medicare Part A and B patients that covers prescription drugs. 


Also, with Part D covering prescription drugs, below are a few key items to let your patients know:

  1. Part D contains the drug formulary. If a patient’s medications are not on the formulary they can request an exception, pay out of pocket, or file an appeal. 
  2. All Part D plans must include at least two drugs from most drug categories/treatment classes and must cover all drugs available in the following categories:
    • HIV/AIDS treatments
    • Antidepressants
    • Antipsychotic medications
    • Anticonvulsive treatments for seizure disorders
    • Immunosuppressant drugs
    • Anticancer drugs (unless covered by Part B)
  3. Part D plans will also cover most vaccines, except for those covered in Part B.
  4. Part D plans do exclude some drugs from being covered by law, these include certain drugs to treat weight loss or gain, and OTC medications.

Your Pharmacy’s Role During Open Enrollment


Medicare Open Enrollment 2023 isn’t just important for your patients, it directly benefits your pharmacy as well. 

When patients switch Medicare plans, this often results in more affordable prescriptions which helps to increase medication adherence. Patients are more likely to stay with the pharmacy that helped them receive their medications at an affordable rate, and that took the time to compare and contrast the best Medicare plan for them, versus leaving for a competitor.


Provide Education and Guidance, the Earlier the Better

It’s important for independent pharmacies to stay on top of the Medicare enrollment conversation so you are not at risk of losing business.

Keep patients informed of Medicare information by building Open Enrollment information and reminders into your daily or weekly pharmacy content. This includes sharing newsletters, blog posts, news articles, and social media posts that tell patients about their Medicare plan options. Be sure to explain what to expect during the Open Enrollment period. Add informational content to your pharmacy website with a resources page or banner.

Setting up one-on-one appointment-based consultations is also a great way to help your customers choose a plan. Adding Medicare Part D comparison consultations to your list of services will help you take that extra step with your patients. With so many plans to choose from, having expert guidance from their pharmacy helps patients identify better and healthier alternatives.

With consultations being a time commitment for pharmacie (often taking 20-30 minutes per individual appointment) using an appointment-based model (ABM) to schedule your day can help to save time and streamline the pharmacy workflow. Look for ABM-type platforms that offer Medicare comparison consultation services as a preset appointment type to reduce friction and maximize the patient experience. 


A Few Ways to Market your New Medicare Enrollment Offerings:

social media
  • Add it to your IVR greeting
  • Send secure 2-way messages to your patients about enrollment season with an appointment sign up link
  • Hang informational signage around your store
  • Print flyers and keep them at your counter or staple them to prescription bags


Digital Pharmacist is committed to helping independent pharmacies succeed. To learn more about how our digital engagement suite can support your pharmacy and patients this Medicare Open Enrollment season, get in touch today.


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