Compare Medicare Prescription Drug Plans
Medicare prescription drug coverage (Part D) adds to your Medicare benefits, helping you pay for both brand-name AND generic medications. Medicare drug plans are offered by private carriers and other private Medicare-approved companies. You can get coverage through Medicare prescription drug plans (PDPs) — that add drug coverage to Original Medicare and some other plans. Also, some Medicare Advantage plans, such as HMOs or PPOs, offer Part D coverage, which may be called MA-PDs.
Find Drug Coverage That Suits Your Needs
All Medicare beneficiaries have to make a decision about Part D coverage. If you don’t take many prescription drugs now, still consider joining a Part D plan because it can help reduce your drug costs and protect against higher costs down the road. Plus, it can provide peace of mind.
If you’re a Medicare newbie and already have other drug coverage, you have new choices to evaluate.
You can join or switch Part D plans between the Annual Open Enrollment Period — October 15 to December 7 each year, with your coverage taking effect January 1 of the next year.
Things to Consider
Before choosing a Medicare drug plan, there are many factors to consider. It may also help if you collect information about any drug coverage you might already have, and a list of medications (and doses) you currently take. Also, gather any notices you receive from Social Security, Medicare, or your current drug plan about changes to the plan.
Note: Your current insurer must tell you whether your drug coverage (if you have it) is creditable prescription drug coverage.
Cost
Prescription drug plans have different monthly premiums that you must pay. How much you pay for every drug depends on which plan you select.
In other words, you pay part of the costs, and Medicare pays part. In addition to the monthly premium, there could be a yearly deductible (some drug plans don’t have one) and copayment/coinsurance. Some Part D plans have different levels of copayments, with different costs for different kinds of drugs.
Also, most prescription drug plans have a coverage gap (aka donut hole). There’s a temporary cap on what the plan will cover for drugs. After you and your plan have spent $4,020 on covered drugs (in 2020), you enter the coverage gap. So, you’ll pay 25% of the plan’s cost for covered brand-name and generic drugs until you hit the end.
Note: Not everyone is guaranteed to enter the coverage gap. Contact Sannes Insurance for more information.
Coverage
Medicare Part D plans may vary in the drugs they cover. Some may have unique rules that you need to follow before they cover a drug. A formulary is a list of the medications that a plan covers. It includes both generic and brand-name drugs, and says how much you pay for each prescription and lists what drugs are in each tier. Every drug plan has its own formulary, so you’ll want to make sure that it covers your drugs.
Medicare drug plans may require prior authorization. Before the plan covers certain prescriptions, you have to prove you meet select criteria — such as your doctor verifying why the drug is “medically necessary” for you — before you get to fill the prescription.
Convenience
Convenience also matters when choosing a Medicare drug plan. Check to make sure your current pharmacy is included in the plan’s network OR there are pharmacies close to you. Drug plans can change their network pharmacies every year.
How to Get Part D Help
When comparing Medicare drug plans, consider your needs in terms of cost, coverage, and convenience. Then, call 509-993-9887 to see which plans are available in your city or state. As always, if you have questions, Sannes Insurance is here for you!