Yes. You do.
I guess you don’t absolutely have to, but you risk spending hundreds or thousands of dollars more on medications than you need to if you don’t look at Medicare Part D plans every year.
For most people, evaluating Part D plans is not a big chore. Plan comparison and enrollment in a new plan, if that’s in your best interest, can be done for the year in as little as 20 to 30 minutes.
In this video, we’ll explain why it’s so vitally important to compare Part D plans every year, even if you don’t take any prescription medications, show you how to compare Part D plans, and include links in the description so you can handle this annual task on your own or have a broker take care of it for you.
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Why should you look at Part D plans every year?
Medicare Part D started in 2006. Prior to that, Medicare provided no coverage for most outpatient drugs. This is a great, relatively new benefit that has made prescription medications far more affordable for people on Medicare.
That said, it is a bit convoluted and has been causing confusion since 2005, when Medicare beneficiaries were first able to enroll in Part D plans.
Part D plans are authorized by Medicare and offered through private insurance companies. Plans have to meet minimum standards set by Medicare that change slightly every year.
So every year, your current Part D plan can change, and so can all the other Part D plans available in your zip code. Also, brand new plans can enter your area, and some current plans may reduce their service area and no longer be in your zip code.
Even if your medications haven’t changed in the past year, your current plan might not be the best fit for you in the new year.
You can completely ignore the Annual Enrollment Period between October 15 and December 7 and stay in the same Part D plan for the next year if you want to, but not knowing what other options are out there could cost you a lot of money.
To a lesser extent, that’s even true for people who don’t take any prescription medications. For clients who fall into that category, we usually recommend enrolling in the Part D plan with the lowest monthly premium to avoid going without coverage and having to pay the Part D late enrollment penalty down the road.
Everything about Part D plans can change every year. The monthly premium, deductible, copays, coinsurance, list of covered medications, and restrictions on those medications.
That’s why you should look at Part D plans every year.
How do you compare Part D plans?
Step 1: Make a list of all your prescription medications with the dosage and frequency for each.
Accuracy is very important here. Copy the information exactly as it’s written on your prescription. If you enter incorrect information, you will get incorrect estimates for Part D plans.
There are big differences in cost between equivalent generic and brand name medications, between low dosages and high dosages, and between taking one dose per day or multiple doses per day.
Most estimator tools online will give you the option of estimating using the standard or most common dose of a medication. While it may be tempting to do that to speed up the process, don’t.
Unless that is the dose you take, you will end up with incorrect information and may end up in a Part D plan that isn’t really the best option for you.
Step 2: List your preferred pharmacy and a few backups, including mail order pharmacies.
Every Part D plan has pharmacy networks. Whether your pharmacy is in a plan’s network will affect how much it will cost to fill your prescription. Having a few different pharmacies on your list will increase the chances of being able to fill your prescriptions for the lowest cost.
Mail order pharmacies for maintenance medications usually offer the lowest cost options with discounts for 90 day supplies of prescription medications.
Step 3: Enter your zip code, medication information, and pharmacies into a Medicare Part D plan estimator.
This is the part that you can do by yourself or have a Medicare plan broker handle for you.
There are Part D estimators available online. Using one of these tools is much faster than visiting each Part D plan’s website individually. Medicare.gov has one. Benefit Consultants – Midwest’s Medicare Part D estimator can be found here.
The value of using these estimators is in the time savings. You enter your information once, and the estimator will tell you how much every single Part D plan available in your zip code will cost based on your medications and pharmacies.
Here are some things to look at when the estimator gives you your personalized list of Part D plans.
1. Total overall cost. This is the place to start to roughly sort all the plans. The total cost includes the monthly premiums, deductibles, copays, and coinsurance you will pay for the entire year based on your medications.
2. Restrictions on your medications. Once the plans are ranked by overall cost, check the first few to see if there are any Prior Authorization, Step Therapy, or Quantity Limit restrictions on your medications. If there aren’t, you are good to go.
If your prescriptions have Prior Authorization or Step Therapy restrictions, check the plans farther down the total cost list to see if a slightly more expensive plan is free of restrictions. It may be worth the extra cost to avoid having to deal with Prior Authorization or Step Therapy.
If you have a Quantity Limit restriction, see if your dosage and frequency fall within it. If they do, it shouldn’t be a problem. If you need more than the allowed quantity, look at more expensive plans.
3. Tweak the options. Once you have a few plans that look like the best options based on your medications, you can change the pharmacy option to your second choice or to mail order if you entered a retail pharmacy or vice versa to see if those changes make a difference to the overall cost for your medications.
This can be straightforward and fairly simple if you take only a few medications, or no medications, but if you have a longer list of medications or take more expensive drugs, it can get complicated quickly.
Need help? We’re here!
All of the above can be done for you at no cost by a Medicare plan broker. Your broker will be able to tell you why they arrived at a particular recommended plan for you based on cost, restrictions, and access to medications.
A broker will also assist with enrolling in a new plan, if that’s best for your situation, and remind you in following years when the Annual Enrollment Period is coming around again and it’s time to compare a new batch of Part D plans.
If you have questions about your Medicare Part D prescription drug coverage, please feel free to give our office a call at 877-312-1414 or schedule a free, no obligation Medicare Plan Consultation.
We’re here to take the confusion out of Medicare Part D and find the best plan for you!
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