Consider these five suggestions when shopping for Medicare Part D plans


As a Medicare beneficiary, you have a many decisions to make. Selecting the right prescription drug plan is one of the most important. If you make the right choice, you can save money and headache, while knowing you have access to the medications you need.

Why we needed a Part D benefit

Did you know that $1 of every $6 Medicare dollars goes toward outpatient prescription drug costs? That’s why it so important to take the time to carefully choose a Part D plan that covers your medications – with potential crucial savings if you are a evaluate your options.

When reviewing Medicare Part D, here are five suggestions to consider.

  1. Know when to window

From October 15 through December 7 you can shop around for a new Part D plan or change your Medicare Advantage coverage for the coming year.

Because most people can’t change plans outside of this open enrollment period, it pays to be prepared. During this period it’s important to remember that changes will almost always take effect starting in January, leaving you the option to change your mind more than once during the fall open enrollment window.

  1. Check your Medicare Advantage plan

If you have a Medicare Advantage plan, you usually have to receive your drug benefits through the plan rather than a separate Part D insurer.

Think about changing your Medicare Advantage plans if your plan’s Part D formulary (drugs that are covered by your insurance provider) for next year would limit your ability to continue taking your current prescriptions. Just make sure the replacement Medicare plan will also cover your current health care providers, in addition to your medications.  Use the plan comparison tool to compare Part D benefits offered by the various carriers.

  1. Check your formularies and drug costs

Plans change their lists of covered drugs (formularies) and the drugs’ costs each year.  Be aware that Part D plans can add requirements that you receive the plan’s approval before covering your current medications next January. This is known as prior-authorization or pre-certification.

If you can’t find a plan that covers all your medications, you may be able to work with your doctor to get your existing plan (that has changed your current medication to require pre-approval) to cover the drug anyway.

Under certain circumstances, your Medicare prescription drug insurer must generally offer enrollees a 90-day filling of their current medications when the plan benefits change from one year to the next. Because there are conditions attached to this policy, known as a “transition fill,” be sure to know your insurer’s rules, while ensuring the plan follows through on its obligations to support you as Medicare beneficiary.

  1. It pays to shop around

The Affordable Care Act closes the Part D donut hole (also known as the coverage gap, where you have to pay for most of the costs of your prescriptions) by 2020. But this is 2016 going into 2017 – and you pay much of the cost of your medications during your donut hole period. So, shopping around can help reduce the cost of this portion.

  1. Part D premiums aren’t everything

Benefits under Part D before, during and after you pass through the donut hole change each year. So it pays to examine your costs under each plan available, with some plans offering generic drugs without copays. If those offerings apply to your medications, you could save a lot of money throughout the year.

In addition, some Part D plans offer enhanced coverage beyond a minimum level of prescription drug benefits required of insurers by the federal government. This can include softening your cost increases when you enter the donut hole or eliminating the donut hole altogether. However, enhanced Part D plans may not pay for themselves with lower copays or better coverage in the donut hole because their higher premiums can more than counter the savings offered by the lower co-pays and deductibles.

Take your time

The best way to select a Part D plan is to pay attention and be a smart shopper. We can help you explore your options.

By taking advantage of available resources, you can be confident that you selected a plan for next year that is more likely to take care of your needs. Remember, you don’t deserve any less!