How Do I Choose the Best Medicare Part D Plan?

It’s one of the most common questions people ask about Medicare.  The answer depends on several factors including your medications, your pharmacy, and how you prefer to receive your Medicare coverage. Here’s what you need to know.

Medicare Part D provides prescription drug coverage in two main ways:

• A stand-alone Part D plan (PDP)- pairs with Original Medicare, has a monthly premium

• A Medicare Advantage Plan (MAPD) that includes drug coverage as part of the plan.  These may have monthly premiums that start at $0. 

What All Part D Plans Have in Common - While these options are packaged differently, Part D coverage works very similarly in both.  No matter which type of plan you choose, there are a few important things to understand.

• Deductible – How much you pay out of pocket first for Name Brand Drugs before the plan kicks in.

• Copay – A fixed amount you pay for each prescription.

• Coinsurance – A percentage of the cost of the drug you are responsible to pay

• A drug formulary is the list of medications a plan covers. Each plan determines whether your medication is covered and how much you will pay.

• Drugs are also placed into tiers. The tier level determines what your copay is.  Lower-cost generics are usually in the lowest tier or two, which typically has a $0 copay or a few dollars.  Name Brand drugs are on the next two tiers, which have a higher copay. Specialty medications are in the highest tier, typically requiring you to pay a percentage of the cost.  Note: The same medication may be placed in a different tier, even within the same carrier.

• Your cost can also vary depending on the pharmacy you use, whether the pharmacy is “preferred” or if you use mail order.  That’s why one person may pay a different price for the exact same medication within the same plan.

One important thing to understand is that plans with lower monthly premiums often have higher deductibles for brand-name medications. Plans with higher premiums may reduce or eliminate deductibles and sometimes offer better coverage for more expensive drugs.  Also, in general, prescriptions tend to be less expensive inside the Medicare Advantage Plans.  That’s why it’s important to compare how your specific medications are covered.

What You Need When Comparing Plans

To properly compare plans, it’s important to have accurate information about your prescriptions, because even small differences can affect your coverage and costs.  It’s important to have ready:

•        A few pharmacy options in mind to compare

•        The exact name and spelling of each medication

•        The dosage and frequency

•         For creams, liquids, or drops: the strength, quantity, and size

The Bottom Line

There is no one-size-fits-all Medicare Part D plan. The best choice depends on your medications, your pharmacy, and your overall needs.  Taking a little time to compare your options can help you avoid unexpected costs and find coverage that truly fits.

ABC Medicare Plans Broker 631-337-3625

Choosing The Right Part D Plan