However, comparing costs and benefits between plans can become confusing, especially if you take multiple medications (as many people in the Medicare program do). Your prescriptions and pharmacy can change what a plan actually costs, so we recommend that you review your drug list with a licensed Medicare Sharks agent before enrolling.
In the meantime, let’s learn more about Medicare Part D plan options.
How to Choose a Medicare Part D Plan
Because each plan has different premiums, deductibles, and copays, comparing them can be difficult. It’s important to consider more than just your premium. Of course, this cost is top of mind for most people. But some plans with lower premiums have higher deductibles or copays. For this reason, we recommend considering the following questions as you compare Part D plans:
– What medications do you take regularly, and how much would you pay for them with a particular plan?
– Are your medications available in generic form, or is the name brand a necessity?
– Do you take multiple medications on a regular basis?
– If you will be enrolling in Medicare soon but currently have different coverage, how quickly do you typically meet your deductible for prescription drug coverage?
– If you compare your medication costs between plans with higher and lower premiums, does the difference negate any savings on premium costs?
– Is your preferred pharmacy in-network for the plans you’re considering?
What Medicare Part D Covers
Plans vary, but Medicare Part D plans usually cover most outpatient prescription medications for both short-term and long-term (chronic) conditions. Sometimes a specific medication may not be covered, but a similar drug in its class will be available.
This is one example of why it’s so critical to carefully compare plans. For some patients, switching to a different but similar medication isn’t a problem. For others, only one medication may work for their particular health issues. If your situation is the latter, it could be vitally important that your plan covers the exact prescription drug that you need.
Medicare Part D plans are also legally required to cover most drugs in the following six protected classes:
– Cancer
– HIV/AIDS
– Antidepressants
– Antipsychotics
– Anticonvulsants
– Immunosuppressants
Additionally, Part D plans cover most commercially available vaccines that aren’t covered by Medicare Part B at no out-of-pocket cost.
Why Prescription Drug Plans Should Be Reviewed Every Year
Every insurance company updates its Medicare drug plan formulary each year on January 1. Sometimes a drug that was covered last year may have been removed or changed to a different tier, new drugs added, etc. You don’t want to get to the pharmacy and learn that your medication is no longer covered or has moved to a higher tier, so it’s a good idea to review your Medicare prescription drug plan annually.
Checklist: What to Compare Before Choosing a Part D Plan
Before you choose a Medicare Part D plan, you should ensure it meets your needs in the following ways:
– You will have coverage for any medications you currently take.
– Your prescription drug costs, between premiums and out-of-pocket expenses, will not be prohibitively expensive.
– You will be able to stay with your pharmacy, if this is important to you.
– You will not need prior authorization for any of your medications. (Some plans require you to receive prior authorization from the insurance company for certain medications.)
If you find differences in these areas when comparing plans, that may help you narrow down the best options.
Current Prescriptions
Making a list of your current prescriptions is one of the best first steps you can take when you choose a Medicare Part D plan. Once you’ve listed the names of all your medications, consider how important they are, whether there are alternatives that also work well for you, or whether you must take one specific medication. You should also make a note of any prescriptions that your doctor has specified must be name-brand and not generic.
This list can help you determine if a given plan is appropriate for your needs, or if another plan would be a better fit.
Formulary and Drug Tiers
Now that you have this list, take a look at the plan’s drug formulary and see what tiers each of your medications fall on. Pay special attention to the medications that are most important—the ones that you rely on for serious conditions, and/or the medications that can’t be substituted. If they are on Tier 1 or 2, that’s a good sign. If they are on Tier 3, you will likely pay more for your medication.
If this is the case, compare the plan with others. In some situations, you may find a medication that’s on Tier 3 for one plan is on Tier 2 for another, and so on.
Preferred Pharmacies
Although you can go to an out-of-network pharmacy, you may pay more for your medications. Some Medicare Part D plans only cover prescriptions at in-network pharmacies or offer a significant discount at their preferred pharmacies. If you want to stay with your current pharmacy, it’s essential to learn if it’s on the list of in-network or preferred pharmacies. If not, you may want to find a plan that includes your pharmacy in-network.
Premiums, Deductibles, and Copays
As discussed earlier, it’s important to understand what you’ll really be paying for each plan, beyond the premium price. Prescription drug coverage for Medicare can be complicated, and some information is often buried in the policy. However, you should be certain that you find out what your deductible is and what your copays will be for all critical medications. If you’re struggling to find the info you need, you may want to talk to a Medicare broker who can help you answer these questions.
Late Enrollment Penalty Risk
If you’re reading this article because you will become eligible for Medicare soon, you should understand the importance of securing a Medicare Part D plan right away. Medicare will apply a permanent monthly surcharge to your premium if you go 63 days without a Part D plan or other creditable prescription drug coverage.
The Part D late enrollment penalty is 1 percent of the national base beneficiary premium added to your monthly premium for every month that you were without creditable coverage. You may be able to avoid the penalty if you have other prescription drug coverage, such as a plan from an employer or union, or if you qualify for the Extra Help program. However, if you believe you are eligible for one of these exceptions, you should make sure before you go without a Medicare Part D plan.
How Medicare Sharks Can Help Compare Drug Plans
We understand how confusing comparing different Medicare Part D plans can be, and we hope the information provided in this article has been helpful. But if you need more information or have specific questions about your situation, please schedule a free consultation with a licensed Medicare Sharks agent before enrolling. We can also help if you’re currently enrolled in a plan but want an annual review to determine if it’s still the best option.
FAQs About Medicare Part D Plans
What do you need to bring to the pharmacy after signing up for a Medicare Part D plan?
After enrolling in a Medicare prescription drug plan, you should receive a card for this plan. This is different from your Medicare card, but you should bring both to the pharmacy so they can verify you are enrolled in Medicare. Additionally, you should bring a photo ID so they can confirm your identity.
Can I use a mail-order pharmacy?
In many cases, yes, but you should check your plan to ensure your mail-in pharmacy is in-network or preferred. Otherwise, you may have to pay for your medications out of pocket.
Can I fill a three-month/six-month/one year supply of my medication?
Again, you will have to check on the specifics of the plan you are considering. Many plans limit the amount of medication they will pay for over a certain time period for both safety and cost reasons.
Do I need a Medicare Part D plan with Medicare Advantage?
In most cases, no. Medicare Advantage is an alternative, private plan meant to replace Original Medicare. Because most Medicare Advantage plans include prescription drug coverage, you do not need a Medicare Part D plan the way you would with Original Medicare. However, you should double-check to be sure your Medicare Advantage includes prescription drug coverage.
However, comparing costs and benefits between plans can become confusing, especially if you take multiple medications (as many people in the Medicare program do). Your prescriptions and pharmacy can change what a plan actually costs, so we recommend that you review your drug list with a licensed Medicare Sharks agent before enrolling.
In the meantime, let’s learn more about Medicare Part D plan options.
How to Choose a Medicare Part D Plan
Because each plan has different premiums, deductibles, and copays, comparing them can be difficult. It’s important to consider more than just your premium. Of course, this cost is top of mind for most people. But some plans with lower premiums have higher deductibles or copays. For this reason, we recommend considering the following questions as you compare Part D plans:
– What medications do you take regularly, and how much would you pay for them with a particular plan?
– Are your medications available in generic form, or is the name brand a necessity?
– Do you take multiple medications on a regular basis?
– If you will be enrolling in Medicare soon but currently have different coverage, how quickly do you typically meet your deductible for prescription drug coverage?
– If you compare your medication costs between plans with higher and lower premiums, does the difference negate any savings on premium costs?
– Is your preferred pharmacy in-network for the plans you’re considering?
What Medicare Part D Covers
Plans vary, but Medicare Part D plans usually cover most outpatient prescription medications for both short-term and long-term (chronic) conditions. Sometimes a specific medication may not be covered, but a similar drug in its class will be available.
This is one example of why it’s so critical to carefully compare plans. For some patients, switching to a different but similar medication isn’t a problem. For others, only one medication may work for their particular health issues. If your situation is the latter, it could be vitally important that your plan covers the exact prescription drug that you need.
Medicare Part D plans are also legally required to cover most drugs in the following six protected classes:
– Cancer
– HIV/AIDS
– Antidepressants
– Antipsychotics
– Anticonvulsants
– Immunosuppressants
Additionally, Part D plans cover most commercially available vaccines that aren’t covered by Medicare Part B at no out-of-pocket cost.
Why Prescription Drug Plans Should Be Reviewed Every Year
Every insurance company updates its Medicare drug plan formulary each year on January 1. Sometimes a drug that was covered last year may have been removed or changed to a different tier, new drugs added, etc. You don’t want to get to the pharmacy and learn that your medication is no longer covered or has moved to a higher tier, so it’s a good idea to review your Medicare prescription drug plan annually.
Checklist: What to Compare Before Choosing a Part D Plan
Before you choose a Medicare Part D plan, you should ensure it meets your needs in the following ways:
– You will have coverage for any medications you currently take.
– Your prescription drug costs, between premiums and out-of-pocket expenses, will not be prohibitively expensive.
– You will be able to stay with your pharmacy, if this is important to you.
– You will not need prior authorization for any of your medications. (Some plans require you to receive prior authorization from the insurance company for certain medications.)
If you find differences in these areas when comparing plans, that may help you narrow down the best options.
Current Prescriptions
Making a list of your current prescriptions is one of the best first steps you can take when you choose a Medicare Part D plan. Once you’ve listed the names of all your medications, consider how important they are, whether there are alternatives that also work well for you, or whether you must take one specific medication. You should also make a note of any prescriptions that your doctor has specified must be name-brand and not generic.
This list can help you determine if a given plan is appropriate for your needs, or if another plan would be a better fit.
Formulary and Drug Tiers
Now that you have this list, take a look at the plan’s drug formulary and see what tiers each of your medications fall on. Pay special attention to the medications that are most important—the ones that you rely on for serious conditions, and/or the medications that can’t be substituted. If they are on Tier 1 or 2, that’s a good sign. If they are on Tier 3, you will likely pay more for your medication.
If this is the case, compare the plan with others. In some situations, you may find a medication that’s on Tier 3 for one plan is on Tier 2 for another, and so on.
Preferred Pharmacies
Although you can go to an out-of-network pharmacy, you may pay more for your medications. Some Medicare Part D plans only cover prescriptions at in-network pharmacies or offer a significant discount at their preferred pharmacies. If you want to stay with your current pharmacy, it’s essential to learn if it’s on the list of in-network or preferred pharmacies. If not, you may want to find a plan that includes your pharmacy in-network.
Premiums, Deductibles, and Copays
As discussed earlier, it’s important to understand what you’ll really be paying for each plan, beyond the premium price. Prescription drug coverage for Medicare can be complicated, and some information is often buried in the policy. However, you should be certain that you find out what your deductible is and what your copays will be for all critical medications. If you’re struggling to find the info you need, you may want to talk to a Medicare broker who can help you answer these questions.
Late Enrollment Penalty Risk
If you’re reading this article because you will become eligible for Medicare soon, you should understand the importance of securing a Medicare Part D plan right away. Medicare will apply a permanent monthly surcharge to your premium if you go 63 days without a Part D plan or other creditable prescription drug coverage.
The Part D late enrollment penalty is 1 percent of the national base beneficiary premium added to your monthly premium for every month that you were without creditable coverage. You may be able to avoid the penalty if you have other prescription drug coverage, such as a plan from an employer or union, or if you qualify for the Extra Help program. However, if you believe you are eligible for one of these exceptions, you should make sure before you go without a Medicare Part D plan.
How Medicare Sharks Can Help Compare Drug Plans
We understand how confusing comparing different Medicare Part D plans can be, and we hope the information provided in this article has been helpful. But if you need more information or have specific questions about your situation, please schedule a free consultation with a licensed Medicare Sharks agent before enrolling. We can also help if you’re currently enrolled in a plan but want an annual review to determine if it’s still the best option.
FAQs About Medicare Part D Plans
What do you need to bring to the pharmacy after signing up for a Medicare Part D plan?
After enrolling in a Medicare prescription drug plan, you should receive a card for this plan. This is different from your Medicare card, but you should bring both to the pharmacy so they can verify you are enrolled in Medicare. Additionally, you should bring a photo ID so they can confirm your identity.
Can I use a mail-order pharmacy?
In many cases, yes, but you should check your plan to ensure your mail-in pharmacy is in-network or preferred. Otherwise, you may have to pay for your medications out of pocket.
Can I fill a three-month/six-month/one year supply of my medication?
Again, you will have to check on the specifics of the plan you are considering. Many plans limit the amount of medication they will pay for over a certain time period for both safety and cost reasons.
Do I need a Medicare Part D plan with Medicare Advantage?
In most cases, no. Medicare Advantage is an alternative, private plan meant to replace Original Medicare. Because most Medicare Advantage plans include prescription drug coverage, you do not need a Medicare Part D plan the way you would with Original Medicare. However, you should double-check to be sure your Medicare Advantage includes prescription drug coverage.