Choosing Medicare Drug Coverage
There are many things to consider when choosing Medicare drug coverage (Medicare Part D). This is a very important decision that can cost you quite a bit if you are not careful.
Steps to help you choose the best Medicare drug coverage to fit your needs:
Decide what your medication needs are.
Make a list of all your current medications. It is important to include the dose and how often you take them. It is also important to consider which pharmacy you will use. Each plan has a list of preferred pharmacies that offer you a lower cost share when you use them. You may also need to consider medications your doctor may add to your list in the near future.
Review your current coverage.
If you are new to Medicare and decide to go with Original Medicare (Part A and Part B), you need to purchase a stand-alone prescription drug plan (Part D). Alternatively, you might opt for a Medicare Advantage plan (Part C) that includes prescription drug coverage. These plans are referred to as MAPD plans.
If you already have either a Part D plan or an MAPD plan, you should review your plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) document each year. These resources will provide valuable notice of any changes in coverage, costs, or formulary for the upcoming year.
Know the Medicare enrollment periods.
It is important that you understand when you can enroll in a PDP plan. For most people there are 2 main enrollment periods. The initial Enrollment Period (IEP) occurs when you first become eligible for Medicare. It typically starts three months before your 65th birthday, includes your birth month, and extends for three months afterward. Each year, The Annual Enrollment Period (AEP) Starts Oct 15 and runs until Dec 7 . During this time, you can make changes to your Medicare coverage.
There are also some SEPs (Special Election Periods) where you can make changes to your plan. Click here to learn more about SEPs.
Please note; certain individuals who have a qualifying disability also have the option to enroll in a Medicare Part D (PDP) plan.
Compare the plan’s total cost.
Because there are many factors that make up the total cost for a Medicare plan, it is important to consider the plan premium, the cost of your medications, deductibles, copayments and co-insurance. You also need to be aware of the coverage gap and catastrophic coverage thresholds, as these may affect your total out-of-pocket costs.
There are a couple ways to compare plan costs. One of the best ways is to locate a licensed Medicare agent who is certified to offer plans from a variety of local carriers. Agents should have access to online quoting tools that can show you plan comparisons. Comparisons include a cost breakdown of each prescription as well as plan premiums and other coverage information. Agents are a great free resource. They can help advise you on how coverage works and which plan will suit your personal needs.
You can also do a plan quote on your own by visiting medicare.gov and using the plan finder. This is a free resource although, it does not offer a consultation like an agent can.
Consider each plan’s star rating.
Each year, Medicare provides star ratings for both PDP plans and MA/MAPD plans. These ratings are based on many factors and have a scale from 1 to 5 stars. A rating of 1 is the lowest and 5 is the highest ranking. Each plan is rated on the quality of the plan which is decided by customer satisfaction of care and customer service provided.
Over time, both medication needs and health status changes; it is important to review your Medicare drug coverage each year during AEP. This will help you prepare for the year ahead and keep costly surprises to a minimum, although none of us has a crystal ball.