Choosing a Medicare Part D Plan – What Is Involved?

When you enroll in Original Medicare, you have two ways to get your drug coverage – you can enroll in a:

1)      prescription drug plan (PDP), otherwise known as Part D, as a stand-alone plan

2)      Medicare Advantage Plan (Part C), which includes a prescription drug plan, commonly known as an “MAPD” plan.  If you join a prescription drug plan while you are enrolled in a Medicare Part C plan, you will be disenrolled from that plan and return to original Medicare.

Please note that if you do not join a drug plan when you are first eligible, you may have to pay a late penalty.  There are, however, two instances that can exempt you from paying the penalty

• You have other creditable prescription drug coverage, i.e. through an employer or union
• You are currently receiving “Extra Help” – You may be eligible if you meet certain income and resource limits.  In this case, Medicare will help pay some of the costs of your prescription drug plan.

You must enroll in a drug plan which is run by an insurance company or any other private company. They also need to be approved by Medicare.

3)      Once you choose your drug plan, you can enroll by

–          going to www.Medicare.gov and enrolling on the Medicare Plan Finder

–          going on the plan’s website

–          calling the plan directly

When you sign up, you will have to give your Medicare number and effective dates for Part A and Part B.

How Do I Find a Medicare Part D Plan?

The best way to find a prescription drug plan is to follow the steps listed below:

• Go online to Medicare’s website: www.medicare.gov/find-a-plan. You will then see a section, “Find Health and Drug Plans”
• You can either use the general search option by putting in your zip code and then click “find”. Or for a more personalized search, you can enter your Medicare information.  More than one county may come up and in that case, just select your county
• On the following page you will have to answer two questions
• Then click on “Continue to Plan Results.”
• You will see a box where you can enter your medications and dosages. If you have no more drugs to enter, then simply click on “My Drug List is Complete”.
• Choose your preferred pharmacy (from the list or by zip code)
• Then click on “Continue to Plan Results”; check “Prescription Drug Plans”; and “Continue to Plan Results, again.
• The results are sorted from the lowest to the highest estimated annual cost (taking into consideration the medication premiums, copays and deductibles that you currently take and the pharmacy where you buy them. You can compare up to three plans at a time, which are printable.

Why Should I Compare Medicare Part D Drug Plans?

It is important for you to compare all the PDPs available to you to make sure you are getting the most value for what you will be paying.  Most seniors are on a budget, having to live on a fixed income and certainly want to find the best plan that is as inexpensive as possible.  Cost effectiveness is the #1 aim here.  The #2 in order of importance is that the drug company you choose provide the highest quality customer service and professionalism, along with excellent ratings and reputation.  Each plan’s benefits may vary regarding their copays, deductibles and premiums.  Most of the drug plans have deductibles but some do not.

It is advantageous to compare also because although a plan may have no deductible, they may charge more for your medications and ultimately not come out as the cheapest plan.

When comparing plans, you also should take into consideration the “Donut Hole” (coverage gap).  The Donut Hole is the portion of the plan where, after a certain point, you will be responsible for 100% of the costs of the medication). Some plans will give you a discount (Donut Hole Discount).  In 2018, the Medicare Part D plan coverage gap begins once you and your plan have spent $3750 on medications.  After this point, you pay no more than 35% of the drug plan’s covered costs for brand-name prescription drugs.  However, some plans may have higher savings, and that’s why you should do a comparison.  For more information on the Donut Hole, contact Medicare or go online at www.Medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html.

If you have chosen a PDP and you decide later that you would like to change it, you may only switch plans from October 15 to December 7 each year.  That said, there are special circumstances during a Special Enrollment Period, i.e. you are moving out of your plan’s service area; you are leaving your employer’s/union health coverage plan, etc.  Please note that if you have Medicare and Medicaid, you may change your prescription drug plan at any time during the year.