Where to Get Help Choosing a Medicare Part D Drug Plan

If you are a Medicare beneficiary, one of the most confusing and difficult tasks is deciding which Medicare Part D drug plan is the right one for you. The following resources should help you better understand how the Medicare system works and where you can get help if you are having difficulty paying for your medications.

One of the most helpful online resources is Medicare's plan finder tool, which allows you to compare prescription drug plans, learn about plans offered in each state, view each plan’s formulary, and download appeal and exception forms. If you are eligible for Medicare, you can select a plan and enroll online. You can get the same information by calling the Medicare help line at 1-800-633-4227.

What You Need to Know When Choosing a Plan

To narrow your options and select the best plan for your needs, consider the following:

  • Are my medications in the drug plan's formulary?
  • Is my pharmacy in the drug plan's network?
  • How much will the drug plan cost me?

When you go to Medicare.gov, use the Medicare Plan Finder to search for and compare coverage options available in your area. A general plan search only requires your zip code. To personalize your search, enter your zip and complete Medicare information.

The Medicare Plan Finder is a tool that helps you search for and compare your available options. The tool is very easy to use—all you need is your zip code, the name of the pharmacy you use, and a list of your prescription medications. After you enter the information, the tool generates a list of Part D plans in order of cost, including the premium for the plan as well as the out-of-pocket costs for your medications.

For Example: Mr. Jones takes five prescription medications—one expensive brand name drug, and four generics. When he used the Medicare Plan Finder, he was provided with 31 drug plan option with a very significant range in the estimated annual cost for his drugs.

In fact, the drug costs varied from $1,671 to $4,489 for 2019. And, the plan with the lowest out-of-pocket costs for Mr. Jones' specific drugs had a monthly premium of $17.50 while the most expensive plan had a monthly premium of $75.30 a month.

Every area of the country has at least 22 stand-alone Part D prescription drug plans available in 2019. The average premium is about $41/month, but premiums vary significantly, with options under $15/month and others that are well over $100/month.

Medicare Part D coverage is integrated with most Medicare Advantage plans (90 percent of all Medicare Advantage plans include Part D coverage in 2019), so if you're already considering Medicare Advantage, you'll likely get built-in Part D coverage; all of the caveats about checking to see if the plan covers your drugs and pharmacy still apply. Keep in mind that if you select a Medicare Advantage plan, you'll get all of your Medicare coverage through that plan. If you want to keep your Original Medicare coverage (and Medigap coverage, if applicable), you'll want to buy a stand-alone Part D plan instead.

Some Tips
Once you find some plans that may be appropriate, you can access additional information about how the plan works and how the costs are calculated. And, you can enroll online on the Medicare site.

Open enrollment for Medicare Part D (and Medicare Advantage) runs from October 15 to December 7 each year, and plan changes you make during that time will take effect on January 1 of the coming year. Enrolling as early as possible in the enrollment period ensures that your new Part D plan can mail your plan materials before January 1, allowing you to use your coverage without delay.

Also, if you're new to Medicare, you'll want to enroll in a Part D plan as soon as you become eligible for Medicare, even if you're not currently taking any medications. If you don't (and assuming you don't have other drug coverage in place that counts as creditable coverage), you'll be subject to a Part D late enrollment penalty when you eventually enroll, and you'll pay higher premiums for life.

And once your initial enrollment window (when you first become eligible) ends, you can only sign up for Medicare Part D during the annual October 15 — December 7 enrollment window. If you go without Part D coverage and then end up needing expensive medications mid-year in a future year, you'd have to wait several months to obtain coverage, even with the higher premium that's assessed when people delay their enrollment.

Other sources of information include:

The State Health Insurance Assistance Program in your state can provide one-on-one counseling and assistance to Medicare patients and their families.

Partnership for Prescription Assistance: Some drug manufacturers offer free or low-cost drugs to qualified Medicare beneficiaries.

Lowering the Costs of Your Medications

Medicare officials suggest the following ways you can lower your costs:

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