How to Find the Best Medicare Part D Plan

Part D is one of the most confusing parts of Medicare.

We’re going to briefly go through how to find the best Part D plan for you, whether you do it on your own or through a broker.

Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…

How to find the best Medicare Part D plan:

Step 1: Don’t look at the plans.

This seems counterintuitive, but don’t waste your time looking at the dozens of Part D plans available in your zip code. Looking at each plan’s monthly premium, star rating, and deductible doesn’t give you any useful information.

Step 2: Find a Medicare Part D estimator tool.

Medicare.gov has a good one. If you are in Wisconsin, Illinois, or Indiana, you can use the Benefit Consultants – Midwest estimator. From there, select Part D quotes.

The estimators all work similarly. You enter your zip code, your medications with dosages, and your pharmacies. The estimator then ranks all the available plans based on the cost of the plans for you.

This gives you a very accurate picture of how much each plan will cost you for the year with the medications you actually take.

Step 3: There are some things to check beyond the cost.

There are three potential restrictions for medications in Medicare Part D plans: Step Therapy, Quantity Limits, and Prior Authorization.

In the drug cost details, check to see if any of your prescriptions has any restrictions.

If your medication has a Prior Authorization restriction, it means that your doctor will need to communicate with the plan in order to be allowed to cover that prescription medication for you.

If your prescription has a Step Therapy restriction on it that means that you will be required to take a, usually, lower cost medication first, and only move up, or step up, to the other medication if you fail on the less expensive medication.

The third restriction is Quantity Limits. For most people, this is not a big deal. On some medications, plans will have a Quantity Limit of 30 per month, or 60 per month, depending on the drug, and you have to stay under that limit. Any excess above their Quantity Limit will be solely your responsibility to pay for.

If any of your medications have a Step Therapy or Prior Authorization restriction, it’s worth looking at the next few plans on the list that are a little more expensive to see if any of those do not have Step Therapy or Prior Authorization restrictions. In general, it’s worth the extra money to not have to deal with Step Therapy or Prior Authorization.

Enroll

Once you’ve found a plan that covers your medications with the fewest possible restrictions at the lowest cost, you can enroll in the plan. This can be done through some estimator tools directly or through a licensed broker.

Coverage Gap/Donut Hole

Something that a lot of people get very worried about with Medicare Part D is the Coverage Gap or Donut Hole. First, it’s important to know that most people never reach the Coverage Gap. Also, the financial risk associated with the Coverage Gap has recently changed significantly.

Due to new regulations, it’s no longer the big financial risk that it used to be. The plans and the drug manufacturers are both responsible for part of the cost of your medications should you reach the Coverage Gap.

If you do end up in the Coverage Gap, the plan estimator tool will show what your costs during the time in the Coverage Gap will be.

I hope that helps explain the process of finding the best Medicare Part D plan for you. If you have any questions, please feel free to contact our office at 877-312-1414 or watch our free video that explains how to find the best Medicare coverage for you.